Provider Demographics
NPI:1982832796
Name:GULLETT, ANGELA MARIA (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:GULLETT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TURNBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6818
Mailing Address - Country:US
Mailing Address - Phone:850-723-0040
Mailing Address - Fax:
Practice Address - Street 1:401 TURNBERRY RD
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6818
Practice Address - Country:US
Practice Address - Phone:850-723-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006784235Z00000X
TX104877235Z00000X
VA2202010370235Z00000X
FLSA5559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885714800Medicaid