Provider Demographics
NPI:1326149824
Name:MCLEOD, ANGELA D (MCD,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:D
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MCLEOD
Other - Last Name:DALZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:630 SHIPWATCH DR.
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6087
Mailing Address - Country:US
Mailing Address - Phone:803-464-5850
Mailing Address - Fax:
Practice Address - Street 1:220 HASEL ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4506
Practice Address - Country:US
Practice Address - Phone:803-774-5500
Practice Address - Fax:803-774-5500
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12086768OtherASHA
SC3891OtherSC LICENSURE
SCSA0742Medicaid