Provider Demographics
NPI:1487805875
Name:COTTER, ANN M (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:COTTER
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 1:21851 NEWLAND ST SPC 62
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7621
Mailing Address - Country:US
Mailing Address - Phone:724-612-7603
Mailing Address - Fax:
Practice Address - Street 1:21851 NEWLAND ST SPC 62
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7621
Practice Address - Country:US
Practice Address - Phone:724-612-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004336L235Z00000X
CA23650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist