Provider Demographics
NPI:1881016178
Name:CARROLL, ANGELA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DOE TAIL CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5139
Mailing Address - Country:US
Mailing Address - Phone:912-398-1439
Mailing Address - Fax:
Practice Address - Street 1:2 DOE TAIL CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5139
Practice Address - Country:US
Practice Address - Phone:912-398-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist