Provider Demographics
NPI:1871726828
Name:ANZALONE, ASHLEY MARIE (SLP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 WELTER DR
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1753
Mailing Address - Country:US
Mailing Address - Phone:708-609-7440
Mailing Address - Fax:
Practice Address - Street 1:8400 SHERIDAN RD.
Practice Address - Street 2:SHERIDAN MEDICAL COMPLEX
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6327
Practice Address - Country:US
Practice Address - Phone:262-658-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3264154235Z00000X
IL146010451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist