Provider Demographics
NPI:1124392972
Name:PARDEE, ANGELA KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:KATHERINE
Last Name:PARDEE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:14701 BARTRAM PARK BLVD
Mailing Address - Street 2:UNIT 407
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5285
Mailing Address - Country:US
Mailing Address - Phone:228-596-2142
Mailing Address - Fax:
Practice Address - Street 1:9803 OLD SAINT AUGUSTINE RD STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8845
Practice Address - Country:US
Practice Address - Phone:228-596-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-12428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist