Provider Demographics
NPI:1720775190
Name:ANTHONY, JANE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CRESTDALE LN APT 43
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1007
Mailing Address - Country:US
Mailing Address - Phone:917-686-4749
Mailing Address - Fax:
Practice Address - Street 1:7469 W LAKE MEAD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1030
Practice Address - Country:US
Practice Address - Phone:702-550-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist