Provider Demographics
NPI:1639496375
Name:SPEECH & LANGUAGE BY ANGELICA, CORP.
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE BY ANGELICA, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETROMPF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC- SLP
Authorized Official - Phone:954-709-5403
Mailing Address - Street 1:819 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6127
Mailing Address - Country:US
Mailing Address - Phone:954-709-5403
Mailing Address - Fax:954-589-1475
Practice Address - Street 1:819 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6127
Practice Address - Country:US
Practice Address - Phone:954-709-5403
Practice Address - Fax:954-589-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001470600Medicaid