Provider Demographics
NPI:1477894749
Name:HUNTER, ANGELA M (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24862 S 366 RD
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8383
Mailing Address - Country:US
Mailing Address - Phone:918-348-1199
Mailing Address - Fax:
Practice Address - Street 1:24862 S 366 RD
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8383
Practice Address - Country:US
Practice Address - Phone:918-348-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist