Provider Demographics
NPI:1184281826
Name:DEJARNETTE, ANGELA F (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:F
Last Name:DEJARNETTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:BEVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N 9TH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1933
Mailing Address - Country:US
Mailing Address - Phone:804-780-7911
Mailing Address - Fax:804-780-6869
Practice Address - Street 1:301 N 9TH ST FL 13
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1933
Practice Address - Country:US
Practice Address - Phone:804-780-7911
Practice Address - Fax:804-780-6869
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty