Provider Demographics
NPI:1376506204
Name:ANGEL, KYLEA J (SLP)
Entity type:Individual
Prefix:
First Name:KYLEA
Middle Name:J
Last Name:ANGEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KYLEA
Other - Middle Name:J
Other - Last Name:STROPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1683 IRISH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WV
Mailing Address - Zip Code:26033-1970
Mailing Address - Country:US
Mailing Address - Phone:304-780-9755
Mailing Address - Fax:304-843-4461
Practice Address - Street 1:1683 IRISH RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WV
Practice Address - Zip Code:26033-1970
Practice Address - Country:US
Practice Address - Phone:304-780-9755
Practice Address - Fax:304-843-4461
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0897235Z00000X
OHSP8018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000238Medicaid