Provider Demographics
NPI:1366864217
Name:SOUTHARD, ANNA BACOT (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:BACOT
Last Name:SOUTHARD
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 1:6632 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3605
Mailing Address - Country:US
Mailing Address - Phone:937-728-0334
Mailing Address - Fax:
Practice Address - Street 1:6632 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3605
Practice Address - Country:US
Practice Address - Phone:937-728-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist