Provider Demographics
NPI:1295040384
Name:WITHROW, ANGELA DANIELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DANIELLE
Last Name:WITHROW
Suffix:
Gender:F
Credentials:MS 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:RR 1 BOX 223A
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-9724
Mailing Address - Country:US
Mailing Address - Phone:540-908-5569
Mailing Address - Fax:
Practice Address - Street 1:1600 ABRAMS RD APT 8
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4490
Practice Address - Country:US
Practice Address - Phone:877-293-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist