Provider Demographics
NPI:1205659802
Name:MUNDA, ANGELA MAY OVALO (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ANGELA MAY
Middle Name:OVALO
Last Name:MUNDA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:ANGELA MAY
Other - Middle Name:OVALO
Other - Last Name:MUNDA-LUSTANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:306 BOLIN DR
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1644
Mailing Address - Country:US
Mailing Address - Phone:509-865-4455
Mailing Address - Fax:
Practice Address - Street 1:403 S JUNIPER ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1017
Practice Address - Country:US
Practice Address - Phone:509-865-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist