Provider Demographics
NPI:1104984863
Name:COMERFORD, ANNE R (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ANNE
Middle Name:R
Last Name:COMERFORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6075 ATLANTIC BLVD
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1349
Mailing Address - Country:US
Mailing Address - Phone:770-209-9826
Mailing Address - Fax:770-209-9876
Practice Address - Street 1:6075 ATLANTIC BLVD
Practice Address - Street 2:SUITE G-1
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1349
Practice Address - Country:US
Practice Address - Phone:770-209-9826
Practice Address - Fax:770-209-9876
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist