Healthcare Provider Details

I. General information

NPI: 1295648269
Provider Name (Legal Business Name): MARYANNE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CENTURY HILL DR
LATHAM NY
12110-2113
US

IV. Provider business mailing address

231 PAWLING AVE APT 1
TROY NY
12180-4836
US

V. Phone/Fax

Practice location:
  • Phone: 518-641-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: