=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649097445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA ROSE HAAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 BETHLEHEM PIKE
-----------------------------------------------------
City | MONTGOMERYVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18936-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-368-4350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 ASHWOOD RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19064-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | PLS002660
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------