Provider Demographics
NPI:1942626718
Name:DUERKSEN, ANGELA TERESA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TERESA
Last Name:DUERKSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N TYLER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3265
Mailing Address - Country:US
Mailing Address - Phone:316-295-6845
Mailing Address - Fax:
Practice Address - Street 1:940 N TYLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3265
Practice Address - Country:US
Practice Address - Phone:316-295-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist