Provider Demographics
NPI:1467907238
Name:OBST, ANGELA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:OBST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-9303
Mailing Address - Country:US
Mailing Address - Phone:434-917-2265
Mailing Address - Fax:
Practice Address - Street 1:1151 THOMAS LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-9303
Practice Address - Country:US
Practice Address - Phone:434-917-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006370235Z00000X
NC10124235Z00000X
GASLP009395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist