Provider Demographics
NPI:1992076350
Name:RAMACHANDRANRAO, ANJANA
Entity type:Individual
Prefix:MRS
First Name:ANJANA
Middle Name:
Last Name:RAMACHANDRANRAO
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 1:132 DORNOCH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4495
Mailing Address - Country:US
Mailing Address - Phone:503-617-9310
Mailing Address - Fax:
Practice Address - Street 1:3201 PARKWOOD LN
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1334
Practice Address - Country:US
Practice Address - Phone:314-291-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist