Provider Demographics
NPI:1922331883
Name:VANDEVENTER, ANGELA M (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:FREDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3120
Mailing Address - Country:US
Mailing Address - Phone:816-931-0177
Mailing Address - Fax:816-561-4592
Practice Address - Street 1:706 W 42ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3120
Practice Address - Country:US
Practice Address - Phone:816-931-0177
Practice Address - Fax:816-561-4592
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006010653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist