Provider Demographics
NPI:1962899625
Name:KAMBOUR, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KAMBOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 TUCKER ST UNIT 546
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1178
Mailing Address - Country:US
Mailing Address - Phone:301-785-7243
Mailing Address - Fax:
Practice Address - Street 1:6845 KNIGHTDALE BLVD
Practice Address - Street 2:102
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9800
Practice Address - Country:US
Practice Address - Phone:919-844-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07770235Z00000X
NC11962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist