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General NPI Number Information
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NPI Number | 1700177581
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Entity Type | Individual
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Provider Name | MS. ANNE B MAHOLM
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Gender | Female
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 3560 W MARKET ST STE 400
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City | FAIRLAWN
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State | OH
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Zip | 44333-2665
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Country | US
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Telephone | 330-668-4041
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Fax | 330-666-5626
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Provider Business Mailing Address
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Address Line | 461 STARLING CT APT 310
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City | WADSWORTH
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State | OH
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Zip | 44281-7925
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Country | US
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Telephone | 330-472-6597
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Fax | 330-666-5626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12144215
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License Number State | MD
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