Provider Demographics
NPI:1720216310
Name:PIERCE, ANGELA C (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:PIERCE
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 1:30 RUSSELL ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8529
Mailing Address - Country:US
Mailing Address - Phone:617-620-6050
Mailing Address - Fax:
Practice Address - Street 1:30 RUSSELL ST UNIT 6
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8529
Practice Address - Country:US
Practice Address - Phone:617-620-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant