Provider Demographics
NPI:1235272824
Name:ANDRUS, ANGELA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12909 SUMMERHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1370
Mailing Address - Country:US
Mailing Address - Phone:630-624-2553
Mailing Address - Fax:
Practice Address - Street 1:19065 HICKORY CREEK PL
Practice Address - Street 2:SUITE #110
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8507
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:708-478-5300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist