Provider Demographics
NPI:1972604833
Name:BARNES, ANGELA RACHELLE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RACHELLE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HUNT CLUB PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-5213
Mailing Address - Country:US
Mailing Address - Phone:304-738-2366
Mailing Address - Fax:304-738-2210
Practice Address - Street 1:11 HUNT CLUB PLZ STE 102
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-5213
Practice Address - Country:US
Practice Address - Phone:304-738-2366
Practice Address - Fax:304-738-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0979235Z00000X
MD05102235Z00000X
VA2202004847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11ZT AROtherSPEECH THERAPY
WV2609907OtherSPEECH THERAPY
MD410592300Medicaid
WV001840673OtherSPEECH THERAPY
WV3810005993Medicaid