Provider Demographics
NPI:1225265879
Name:LANNAN, ANGELA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LANNAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:DAWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 LEVI ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7786
Mailing Address - Country:US
Mailing Address - Phone:570-428-3572
Mailing Address - Fax:888-939-4190
Practice Address - Street 1:51 LEVI ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-7786
Practice Address - Country:US
Practice Address - Phone:570-428-3572
Practice Address - Fax:888-939-4190
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist