Provider Demographics
NPI:1043324726
Name:HART, ANGELA (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1326
Mailing Address - Country:US
Mailing Address - Phone:419-537-0764
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-539-2900
Practice Address - Fax:419-248-2901
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12052345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist