Provider Demographics
NPI:1598981136
Name:THUDIUM, ANGELA MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:THUDIUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13969 MARQUESAS WAY
Mailing Address - Street 2:#208 B
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6040
Mailing Address - Country:US
Mailing Address - Phone:310-968-0938
Mailing Address - Fax:310-822-2592
Practice Address - Street 1:13969 MARQUESAS WAY
Practice Address - Street 2:#208 B
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6040
Practice Address - Country:US
Practice Address - Phone:310-968-0938
Practice Address - Fax:310-822-2592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist