Provider Demographics
NPI:1144359951
Name:KRAJCIN, ANNA MARIE (CCC-SLP, BCBA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:KRAJCIN
Suffix:
Gender:F
Credentials:CCC-SLP, BCBA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:TAGGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1485 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1120
Mailing Address - Country:US
Mailing Address - Phone:925-708-4565
Mailing Address - Fax:
Practice Address - Street 1:1485 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1120
Practice Address - Country:US
Practice Address - Phone:925-672-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21451103K00000X
CASLP 13526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASLP 13526OtherMEDICAL LICENSE