Healthcare Provider Details

I. General information

NPI: 1144359951
Provider Name (Legal Business Name): ANNA MARIE KRAJCIN CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE TAGGERT

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 COVENTRY RD
CONCORD CA
94518-1120
US

IV. Provider business mailing address

1485 COVENTRY RD
CONCORD CA
94518-1120
US

V. Phone/Fax

Practice location:
  • Phone: 925-672-9440
  • Fax:
Mailing address:
  • Phone: 925-708-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP 13526
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-21451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: