Provider Demographics
NPI:1801009535
Name:ANGELL, TERRILL (MA, FAAA)
Entity Type:Individual
Prefix:
First Name:TERRILL
Middle Name:
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST STE 212
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2537
Mailing Address - Country:US
Mailing Address - Phone:870-405-3172
Mailing Address - Fax:808-263-4368
Practice Address - Street 1:407 ULUNIU ST STE 212
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2537
Practice Address - Country:US
Practice Address - Phone:870-405-3172
Practice Address - Fax:808-263-4368
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK83231H00000X
HIAUD-128231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAU7454Medicaid