Provider Demographics
NPI:1619206943
Name:DALTON, ANGELA VERONICA GIFT (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:VERONICA GIFT
Last Name:DALTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 PLEASANT HOME RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-9053
Mailing Address - Country:US
Mailing Address - Phone:828-406-0369
Mailing Address - Fax:
Practice Address - Street 1:303 E 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8905
Practice Address - Country:US
Practice Address - Phone:828-406-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4245235Z00000X
NC10849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist