Provider Demographics
NPI:1992748016
Name:FONTENOT, ANN MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16835 DEER CREEK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5803
Mailing Address - Country:US
Mailing Address - Phone:281-379-4373
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5803
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2018-02-23
Deactivation Date:2012-06-01
Deactivation Code:
Reactivation Date:2018-02-20
Provider Licenses
StateLicense IDTaxonomies
TX13270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179362201Medicaid