Provider Demographics
NPI:1508291196
Name:MEJIA, ANGELA S (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:S
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:S
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:473 W SILVER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5817
Mailing Address - Country:US
Mailing Address - Phone:206-850-9576
Mailing Address - Fax:
Practice Address - Street 1:473 W SILVER CREEK CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5817
Practice Address - Country:US
Practice Address - Phone:206-850-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA85622355S0801X
AZSLP8562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant