Provider Demographics
NPI:1629836275
Name:OBRIEN, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25340 250TH ST
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:MO
Mailing Address - Zip Code:63440-2180
Mailing Address - Country:US
Mailing Address - Phone:217-430-3244
Mailing Address - Fax:
Practice Address - Street 1:21504 STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452-2467
Practice Address - Country:US
Practice Address - Phone:573-209-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220306092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant