Provider Demographics
NPI:1104881473
Name:REEDER, ANGIE (PHD CCC-A)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:
Last Name:REEDER
Suffix:
Gender:F
Credentials:PHD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TARA CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 SUNNYSIDE AVE
Practice Address - Street 2:2101 HAWORTH
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7534
Practice Address - Country:US
Practice Address - Phone:785-864-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1399231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200401210BMedicaid