Provider Demographics
NPI:1114431277
Name:LAMPS, ANGIE (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:LAMPS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-3901
Mailing Address - Country:US
Mailing Address - Phone:815-488-1519
Mailing Address - Fax:
Practice Address - Street 1:1800 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1615
Practice Address - Country:US
Practice Address - Phone:815-223-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist