Provider Demographics
NPI:1528160033
Name:ANDERS, DANA (MA CCC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:ANDERS
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1608
Mailing Address - Country:US
Mailing Address - Phone:760-902-5035
Mailing Address - Fax:760-770-3511
Practice Address - Street 1:35900 BOB HOPE DR STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1767
Practice Address - Country:US
Practice Address - Phone:760-902-5035
Practice Address - Fax:760-770-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 3426OtherSPEECH PATHOLOGY LICENSE