Provider Demographics
NPI:1710228317
Name:CRAVER, ANGELA DAWN (HIS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:CRAVER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:331-229-8208
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:3211 4TH ST
Practice Address - Street 2:B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5145
Practice Address - Country:US
Practice Address - Phone:903-758-8346
Practice Address - Fax:903-757-7876
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50636237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist