Provider Demographics
NPI:1184021875
Name:BRYANT, ANGELA MARIE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:7667 SUMMERLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9377
Mailing Address - Country:US
Mailing Address - Phone:513-759-8100
Mailing Address - Fax:
Practice Address - Street 1:7667 SUMMERLIN BLVD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9377
Practice Address - Country:US
Practice Address - Phone:513-759-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist