Healthcare Provider Details

I. General information

NPI: 1265365910
Provider Name (Legal Business Name): ANNE GODFREY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

2358 46TH AVE
SAN FRANCISCO CA
94116-2003
US

V. Phone/Fax

Practice location:
  • Phone: 626-833-0710
  • Fax:
Mailing address:
  • Phone: 626-833-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: