Provider Demographics
NPI:1437395530
Name:MUSGRAVE, ANGELA CAROLE (MSC, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROLE
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:MSC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10382 TRAILWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-4765
Mailing Address - Country:US
Mailing Address - Phone:561-523-5377
Mailing Address - Fax:
Practice Address - Street 1:10382 TRAILWOOD CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-4765
Practice Address - Country:US
Practice Address - Phone:561-523-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020997900Medicaid
FL887613400Medicaid
FL002272700Medicaid