Provider Demographics
NPI:1780822759
Name:JOHN, ANGELA LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:JOHN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 82ND ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3215
Mailing Address - Country:US
Mailing Address - Phone:806-798-3600
Mailing Address - Fax:806-798-3601
Practice Address - Street 1:4505 82ND ST
Practice Address - Street 2:SUITE 8
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3215
Practice Address - Country:US
Practice Address - Phone:806-798-3600
Practice Address - Fax:806-798-3601
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80162231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447269402Medicaid