Provider Demographics
NPI:1285249938
Name:PARLE-FRESQUEZ, ANGELICA MARIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:PARLE-FRESQUEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:PARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5908 NW 38TH AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-5410
Mailing Address - Country:US
Mailing Address - Phone:713-305-0992
Mailing Address - Fax:
Practice Address - Street 1:EARLY CHILDHOOD ASSESSMENT CENTER - LIESER SCHOOL
Practice Address - Street 2:301 S. LIESER RD
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-313-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103695235Z00000X
WALL61097245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist