Provider Demographics
NPI:1053507830
Name:DOUGHERTY, ANNE M (AUD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:ARRAZCAETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1015 CHESTNUT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4303
Mailing Address - Country:US
Mailing Address - Phone:215-413-0800
Mailing Address - Fax:215-413-0808
Practice Address - Street 1:1015 CHESTNUT ST STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4303
Practice Address - Country:US
Practice Address - Phone:215-413-0800
Practice Address - Fax:215-413-0808
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00073200231H00000X
DEO2-0000192237600000X
NJB0939237600000X
PAAT006091231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter