Provider Demographics
NPI:1275734006
Name:WASHINGTON, ANGEL Z (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:Z
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:MS
Other - First Name:ANGEL
Other - Middle Name:ZANETTA
Other - Last Name:WILBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED,CCC-SLP
Mailing Address - Street 1:3100 HIGHGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7992
Mailing Address - Country:US
Mailing Address - Phone:404-550-4058
Mailing Address - Fax:
Practice Address - Street 1:3100 HIGHGREEN TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-7992
Practice Address - Country:US
Practice Address - Phone:404-550-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA884199412AMedicaid