Provider Demographics
NPI:1225186414
Name:MENNEFIELD, ANGELA J (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:J
Last Name:MENNEFIELD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 CENTURY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8796
Mailing Address - Country:US
Mailing Address - Phone:901-488-0977
Mailing Address - Fax:
Practice Address - Street 1:6809 CENTURY OAKS DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8796
Practice Address - Country:US
Practice Address - Phone:901-488-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist