Provider Demographics
NPI:1861378960
Name:TUCKER, ANNAMARIE ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:ELIZABETH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:ELIZABETH
Other - Last Name:PORTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8045 METCALF AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3869
Mailing Address - Country:US
Mailing Address - Phone:770-696-3900
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD UNIT B
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-213-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist