Healthcare Provider Details

I. General information

NPI: 1518114636
Provider Name (Legal Business Name): NANCY ANN ANDERSON M.S.,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE DEPT. OF SPEECH AND HEARING
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

207 FOOTE AVE DEPT. OF SPEECH AND HEARING
JAMESTOWN NY
14701-7077
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-8194
  • Fax: 716-664-8418
Mailing address:
  • Phone: 716-664-8194
  • Fax: 716-664-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000955-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000010491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: