Provider Demographics
NPI:1679041792
Name:GASPER, ANGELA THREETON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:THREETON
Last Name:GASPER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 TIGER LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6253
Mailing Address - Country:US
Mailing Address - Phone:985-687-4719
Mailing Address - Fax:
Practice Address - Street 1:3691 BEN WALTERS LN STE 4
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7750
Practice Address - Country:US
Practice Address - Phone:907-235-6044
Practice Address - Fax:907-235-2644
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK138918235Z00000X
LA7234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist