Provider Demographics
NPI:1598944464
Name:THOMAS-COLE, ANGELA J (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:J
Last Name:THOMAS-COLE
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 1:1220 RIVER OAKS DR UNIT F
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1354
Mailing Address - Country:US
Mailing Address - Phone:843-571-2700
Mailing Address - Fax:
Practice Address - Street 1:1220 RIVER OAKS DR UNIT F
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-1354
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4211235Z00000X
TX24659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist