Provider Demographics
NPI:1013182997
Name:HARVEY, ANGELA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2997
Mailing Address - Country:US
Mailing Address - Phone:215-805-2113
Mailing Address - Fax:
Practice Address - Street 1:3075 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1538
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000022040002OtherMEDICAL ASSISTANCE