Provider Demographics
NPI:1437432796
Name:SIMPSON, ANGELA M (MCD, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MCD, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MARCH MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6409
Mailing Address - Country:US
Mailing Address - Phone:870-680-3397
Mailing Address - Fax:
Practice Address - Street 1:85 MARCH MILL RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-6409
Practice Address - Country:US
Practice Address - Phone:870-680-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist