Provider Demographics
NPI:1417502667
Name:GLASS BISHOP, ANGIE MARIA (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MARIA
Last Name:GLASS BISHOP
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 1:327 AUTUMN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9699
Mailing Address - Country:US
Mailing Address - Phone:270-678-5417
Mailing Address - Fax:
Practice Address - Street 1:327 AUTUMN RIDGE RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9699
Practice Address - Country:US
Practice Address - Phone:270-678-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist