Provider Demographics
NPI:1346280252
Name:ANDERSON, ANGELA E (AUD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-1258
Mailing Address - Country:US
Mailing Address - Phone:817-282-8402
Mailing Address - Fax:817-285-6182
Practice Address - Street 1:1550 NORWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3646
Practice Address - Country:US
Practice Address - Phone:817-282-8402
Practice Address - Fax:817-285-6182
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50913237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80396AOtherBCBS
TX132647209Medicaid
TX0946188Medicaid
TXS36141Medicare UPIN
TX8G1376Medicare PIN
TX8F3573Medicare PIN