Provider Demographics
NPI:1215341474
Name:MONK, ANGELA HARDIMON (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:HARDIMON
Last Name:MONK
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 1:1707 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873-8405
Mailing Address - Country:US
Mailing Address - Phone:217-419-0686
Mailing Address - Fax:
Practice Address - Street 1:1707 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873-8405
Practice Address - Country:US
Practice Address - Phone:217-419-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist