Provider Demographics
NPI:1972184224
Name:KALT, ANGELENA H (HIS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELENA
Middle Name:H
Last Name:KALT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82440-0721
Mailing Address - Country:US
Mailing Address - Phone:307-754-3464
Mailing Address - Fax:307-764-1672
Practice Address - Street 1:557 MAIN ST
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:WY
Practice Address - Zip Code:82440-5004
Practice Address - Country:US
Practice Address - Phone:307-254-5873
Practice Address - Fax:307-764-1672
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY204237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist