Provider Demographics
NPI:1346437704
Name:RENTEL, ANGELA G (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:RENTEL
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 1:11695 HWY N
Mailing Address - Street 2:
Mailing Address - City:PILOT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65276
Mailing Address - Country:US
Mailing Address - Phone:660-248-3800
Mailing Address - Fax:660-248-3702
Practice Address - Street 1:705 LUCKY ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1140
Practice Address - Country:US
Practice Address - Phone:660-248-3800
Practice Address - Fax:660-248-2610
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist