Provider Demographics
NPI:1740839380
Name:SCHULTZ, ANGELA R (MS CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1305
Mailing Address - Country:US
Mailing Address - Phone:724-846-8255
Mailing Address - Fax:724-647-1232
Practice Address - Street 1:2400 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1305
Practice Address - Country:US
Practice Address - Phone:724-846-8255
Practice Address - Fax:724-647-1232
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL008421OtherSTATE LICENSE