Provider Demographics
NPI:1487217758
Name:YANCEY, ANGELA LAMB (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LAMB
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 WATERFORD OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-7226
Mailing Address - Country:US
Mailing Address - Phone:210-393-5880
Mailing Address - Fax:
Practice Address - Street 1:2000 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1637
Practice Address - Country:US
Practice Address - Phone:210-393-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16927235Z00000X
CA28357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29457552Medicaid