Provider Demographics
NPI:1467675025
Name:HODGES, ANGELA DENISE (DT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:HODGES
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6778 N SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-9387
Mailing Address - Country:US
Mailing Address - Phone:815-978-3018
Mailing Address - Fax:815-425-2119
Practice Address - Street 1:6778 N SUMMIT DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-9387
Practice Address - Country:US
Practice Address - Phone:815-978-3018
Practice Address - Fax:815-425-2119
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist