Provider Demographics
NPI:1841642139
Name:HARDWICK, ANGELA MICHELLE (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CAROLYNS CV
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7176
Mailing Address - Country:US
Mailing Address - Phone:502-492-0296
Mailing Address - Fax:
Practice Address - Street 1:ASCB THERAPY
Practice Address - Street 2:4603 TIMBER WALK CT.
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:888-830-3233
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist