Provider Demographics
NPI:1316472731
Name:SIMONOWICZ, ANGELA KELLER (AUD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KELLER
Last Name:SIMONOWICZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:PATRICE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:LA COSTE
Mailing Address - State:TX
Mailing Address - Zip Code:78039-0441
Mailing Address - Country:US
Mailing Address - Phone:830-931-1815
Mailing Address - Fax:
Practice Address - Street 1:1940 CARSWELL AVE BLDG 7002
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5514
Practice Address - Country:US
Practice Address - Phone:210-292-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81449231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist