Provider Demographics
NPI:1912164328
Name:MCNABB, ANGELA JO (MS CCC-A)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:MCNABB
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JO
Other - Last Name:LEDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:40680 GARFIELD RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4016
Mailing Address - Country:US
Mailing Address - Phone:586-333-5405
Mailing Address - Fax:586-421-4316
Practice Address - Street 1:40680 GARFIELD RD STE 1B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4016
Practice Address - Country:US
Practice Address - Phone:586-333-5405
Practice Address - Fax:586-421-4316
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000256237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter