Provider Demographics
NPI:1710296819
Name:SANDERSON, ANGELA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JEZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 KATHLYN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3817
Mailing Address - Country:US
Mailing Address - Phone:302-598-8369
Mailing Address - Fax:
Practice Address - Street 1:32 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4660
Practice Address - Country:US
Practice Address - Phone:302-328-2580
Practice Address - Fax:302-328-6262
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0001192235Z00000X
MD666181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist