Provider Demographics
NPI:1205573045
Name:PHELPS, ANGELA RENEE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5090
Mailing Address - Country:US
Mailing Address - Phone:843-875-1605
Mailing Address - Fax:
Practice Address - Street 1:158 PECAN DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5090
Practice Address - Country:US
Practice Address - Phone:843-875-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist