Provider Demographics
NPI:1023329083
Name:SCHUELLER, ANGIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:SCHUELLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SCHUELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MAIL STOP: 11102D
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-2066
Mailing Address - Fax:651-254-0910
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP: 11102D
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-2066
Practice Address - Fax:651-254-0910
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist