Provider Demographics
NPI:1174133250
Name:BOLAND, ANNEMARIE MICHELLE (SPEECH/LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:MICHELLE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:SPEECH/LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4105
Mailing Address - Country:US
Mailing Address - Phone:716-534-4984
Mailing Address - Fax:
Practice Address - Street 1:630 66TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2212
Practice Address - Country:US
Practice Address - Phone:716-286-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist