Provider Demographics
NPI:1326315649
Name:MERCED, ANGELA LAWALL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LAWALL
Last Name:MERCED
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WALBERT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3223
Mailing Address - Country:US
Mailing Address - Phone:585-993-2703
Mailing Address - Fax:
Practice Address - Street 1:750 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14615-1230
Practice Address - Country:US
Practice Address - Phone:585-966-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016218-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist