Provider Demographics
NPI:1023421112
Name:SPICE, ANN MARIE
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:SPICE
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 1:576 SONG BIRD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8488
Mailing Address - Country:US
Mailing Address - Phone:440-365-6282
Mailing Address - Fax:
Practice Address - Street 1:13070 DURKEE RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1122
Practice Address - Country:US
Practice Address - Phone:440-748-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.0752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist