Provider Demographics
NPI:1518446830
Name:ANKLAM, ANGELA MARIE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:ANKLAM
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 1:604 UTTERBACK STORE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3328
Mailing Address - Country:US
Mailing Address - Phone:703-626-4001
Mailing Address - Fax:
Practice Address - Street 1:1739 KIRBY RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4817
Practice Address - Country:US
Practice Address - Phone:703-536-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist