Healthcare Provider Details

I. General information

NPI: 1093819633
Provider Name (Legal Business Name): ANNE MARIE HOLCHAUER MASTER OF SCIENCE SL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICKS PLACE
PORT HENRY NY
12974
US

IV. Provider business mailing address

388 SAM SPEAR RD
WESTPORT NY
12993
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-3801
  • Fax: 518-546-3785
Mailing address:
  • Phone: 518-962-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0109491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: