Physician Compare National (NPI:1831436203)

HEALTHCARE PROVIDER: ANN-MARIE ALICE ELIA MA, CCC-SLP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1831436203
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395174239
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200329000256
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DYKSTRA
	Individual professional last name
Provider First Name	ANN-MARIE
	Individual professional first name
Provider Middle Name	ALICE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	QUALIFIED SPEECH LANGUAGE PATHOLOGIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	32701 LAKESHORE DR
	Group Practice or individual's line 1 address
City	TAVARES
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	327785024
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y