Provider Demographics
NPI:1467773135
Name:KLEINEDLER, ANGELA DIANE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DIANE
Last Name:KLEINEDLER
Suffix:
Gender:F
Credentials:MA CCC-SLP
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Mailing Address - Street 1:314 MAIN ST E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2448
Mailing Address - Country:US
Mailing Address - Phone:952-758-5775
Mailing Address - Fax:952-758-5778
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-758-5775
Practice Address - Fax:952-758-5778
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN8646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist