Basic Information
| Provider Information | |||||||||
| NPI: | 1548518822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASSES | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | REBEKAH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 RIVA RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302636712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068817330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2959 SHARPSBURG MCCULLUM RD UNIT C | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706830250 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2012 | ||||||||
| LastUpdateDate: | 08/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 007861 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.