Provider Demographics
NPI:1639500671
Name:KLEIN, ANGELA K (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:KLEIN
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 1:9624 PHEASANT BND
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2760
Mailing Address - Country:US
Mailing Address - Phone:618-791-7983
Mailing Address - Fax:
Practice Address - Street 1:308 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-1244
Practice Address - Country:US
Practice Address - Phone:618-224-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist