Provider Demographics
NPI:1346614864
Name:SANTANA, ANGELA PAOLA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:PAOLA
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12251
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-2251
Mailing Address - Country:US
Mailing Address - Phone:850-339-2778
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 12251
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002-2251
Practice Address - Country:US
Practice Address - Phone:850-339-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242003695OtherIL SLP LICENSE