Provider Demographics
NPI:1770759979
Name:CLANCY, ANNEMARIE B (MA CCCSLP)
Entity type:Individual
Prefix:MS
First Name:ANNEMARIE
Middle Name:B
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BOWIE ROAD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70047
Mailing Address - Country:US
Mailing Address - Phone:985-435-4811
Mailing Address - Fax:985-449-2548
Practice Address - Street 1:290 BOWIE ROAD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70047
Practice Address - Country:US
Practice Address - Phone:985-493-4782
Practice Address - Fax:985-449-2548
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist