Healthcare Provider Details

I. General information

NPI: 1619709433
Provider Name (Legal Business Name): ANNABELLE CESSNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SHERMAN CIR NE
MASSILLON OH
44646-5219
US

IV. Provider business mailing address

314 BEITLER AVE NE
NEW PHILADELPHIA OH
44663-2917
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-9988
  • Fax:
Mailing address:
  • Phone: 330-447-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20242901-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: