Provider Demographics
NPI:1295981462
Name:SMITH, ANGELA RENEE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:WORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:646 OLD QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBERRY
Mailing Address - State:PA
Mailing Address - Zip Code:17339-9705
Mailing Address - Country:US
Mailing Address - Phone:717-932-1975
Mailing Address - Fax:
Practice Address - Street 1:5225 WILSON LN
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6663
Practice Address - Country:US
Practice Address - Phone:717-591-8063
Practice Address - Fax:717-697-6576
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004861L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist