Healthcare Provider Details

I. General information

NPI: 1629375852
Provider Name (Legal Business Name): ANNMARIE HENSON REEBENACKER M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNMARIE HENSON

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ALLDS ST
NASHUA NH
03060-4711
US

IV. Provider business mailing address

18433 ROSCOE BLVD #204
NORTHRIDGE CA
91325-4108
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-0090
  • Fax:
Mailing address:
  • Phone: 818-727-7020
  • Fax: 818-727-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: