Provider Demographics
NPI:1770092793
Name:CANGELOSI, BRITTANY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CANGELOSI
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 1:3354 GREYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1096
Mailing Address - Country:US
Mailing Address - Phone:229-244-3552
Mailing Address - Fax:299-244-7030
Practice Address - Street 1:3354 GREYSTONE WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1096
Practice Address - Country:US
Practice Address - Phone:229-244-3552
Practice Address - Fax:299-244-7030
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist