MEDICARE: ANNA CHRISTINA VIPOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	15386	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15386	OTHER	CA	CA SLP LICENSE

General Provider Information

NPI Number	:	1275189409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CHRISTINA VIPOND

Provider Business Mailing Address
First Line	:	1400 THISTLEWOOD WAY
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-6124
Country	:	US
Telephone Number	:	916-869-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 P ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5300
Country	:	US
Telephone Number	:	916-869-5233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “ ANNA CHRISTINA VIPOND ” Practice Location

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