Provider Demographics
NPI:1285997874
Name:PIKUL, ANGELA JEAN (MSCCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:PIKUL
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:RIVECCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:5 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-2420
Mailing Address - Country:US
Mailing Address - Phone:315-736-9561
Mailing Address - Fax:
Practice Address - Street 1:10 FISHER AVE
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:NY
Practice Address - Zip Code:13407-1537
Practice Address - Country:US
Practice Address - Phone:315-866-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000964-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist