Provider Demographics
NPI:1396280129
Name:LEON, ANGELA YADIRA (CCC-SLP, TSHH)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:YADIRA
Last Name:LEON
Suffix:
Gender:F
Credentials:CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 28TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2359
Mailing Address - Country:US
Mailing Address - Phone:201-618-8641
Mailing Address - Fax:
Practice Address - Street 1:818 28TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2359
Practice Address - Country:US
Practice Address - Phone:201-618-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017702-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist