MEDICARE: MRS. ANN WILLARD MS,CCCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A0193	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A0193	OTHER	WV	STATE LICENSE

General Provider Information

NPI Number	:	1174619183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN WILLARD MS,CCCA

Provider Business Mailing Address
First Line	:	830 PENNSYLVANIA AVE STE 204
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3389
Country	:	US
Telephone Number	:	304-388-2980
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 PENNSYLVANIA AVE STE 204
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3389
Country	:	US
Telephone Number	:	304-388-2980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/30/2025

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