Provider Demographics
NPI:1356672364
Name:ROCKOW, ANGELA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ROCKOW
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 1:1640 N DORAL WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7576
Mailing Address - Country:US
Mailing Address - Phone:928-526-1421
Mailing Address - Fax:
Practice Address - Street 1:11490 PURPLE SAGE DRIVE
Practice Address - Street 2:OAK CREEK SCHOOL
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325
Practice Address - Country:US
Practice Address - Phone:928-639-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist