Provider Demographics
NPI:1790298966
Name:SHOULER, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHOULER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:DAUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED BCBA LBS
Mailing Address - Street 1:1728 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1852
Mailing Address - Country:US
Mailing Address - Phone:570-709-4744
Mailing Address - Fax:
Practice Address - Street 1:245 BETHEL RD
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1561
Practice Address - Country:US
Practice Address - Phone:570-709-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABACB260521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst