Individual provider Active NPI

Anne L Seaboldt

  • Speech-Language Pathologist
  • New Fairfield, CT
National Provider Identifier
1205089158
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
004670-1 Issued in NY
Practice address
15 Pondfield Rd
New Fairfield, CT 06812-2652
Phone
(203) 746-8084
Fax
(203) 746-8084
NPI assigned
Oct 23, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 004670-1 NY Primary
Speech-Language Pathologist 235Z00000X 003940 CT

Addresses

Primary practice location

15 Pondfield Rd
New Fairfield, CT 06812-2652

Mailing address

15 Pondfield Rd
New Fairfield, CT 06812-2652
Phone (203) 746-8084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
003940CTMDClinical Social Worker
004670-1NYMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224720000000",
    "number": "1205089158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PONDFIELD RD",
            "city": "NEW FAIRFIELD",
            "state": "CT",
            "postal_code": "068122652",
            "telephone_number": "203-746-8084",
            "fax_number": "203-746-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PONDFIELD RD",
            "city": "NEW FAIRFIELD",
            "state": "CT",
            "postal_code": "068122652",
            "telephone_number": "203-746-8084",
            "fax_number": "203-746-8084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEABOLDT",
        "first_name": "ANNE",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-23",
        "last_updated": "2008-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "004670-1",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "003940",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.