Provider Demographics
NPI:1093291858
Name:ROMERO, ANGELINA LESLIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:LESLIE
Last Name:ROMERO
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 1:2775 POLO CLUB BLVD UNIT 329
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8364
Mailing Address - Country:US
Mailing Address - Phone:270-217-1893
Mailing Address - Fax:
Practice Address - Street 1:401 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1766
Practice Address - Country:US
Practice Address - Phone:270-247-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist