Provider Demographics
NPI:1780604942
Name:WOOTEN, ANGELA (MS, CCC-A)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 MENCHACA RD STE E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1646
Mailing Address - Country:US
Mailing Address - Phone:512-444-8684
Mailing Address - Fax:512-444-8697
Practice Address - Street 1:4403 MENCHACA RD STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1646
Practice Address - Country:US
Practice Address - Phone:512-444-8684
Practice Address - Fax:512-444-8697
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50252231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022376002Medicaid
TX0223760-01Medicaid
00732VMedicare UPIN
TX022376002Medicaid
TX0223760-01Medicaid