Provider Demographics
NPI:1801089883
Name:GATLIN, ANGELA CRABTREE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CRABTREE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ORANGE ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-4567
Mailing Address - Country:US
Mailing Address - Phone:601-550-7270
Mailing Address - Fax:
Practice Address - Street 1:8 ORANGE ORCHARD DR
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-4567
Practice Address - Country:US
Practice Address - Phone:601-550-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist