Provider Demographics
NPI:1679467039
Name:BOTTOMLEY, ANNAH GRACE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ANNAH
Middle Name:GRACE
Last Name:BOTTOMLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ANNAH
Other - Middle Name:GRACE
Other - Last Name:JAFFE-TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13903 TRAMONTO HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7014
Mailing Address - Country:US
Mailing Address - Phone:843-505-1423
Mailing Address - Fax:
Practice Address - Street 1:7418 JOHN SMITH DR STE 1105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6020
Practice Address - Country:US
Practice Address - Phone:210-992-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker