Provider Demographics
NPI:1194973016
Name:ANDERSON, ANGELA ROSE (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:ROSE
Other - Last Name:GUARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51660231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286097502Medicaid
TX286097503Medicaid
TX286097504Medicaid
TX510695YKTXMedicare PIN
TX510695YKTUMedicare PIN
TX510695YKTVMedicare PIN