Provider Demographics
NPI:1396969432
Name:TREWARTHA, ANGELA SUSAN (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUSAN
Last Name:TREWARTHA
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16114 FLAGG POND LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3338
Mailing Address - Country:US
Mailing Address - Phone:239-410-7518
Mailing Address - Fax:
Practice Address - Street 1:4550 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1017
Practice Address - Country:US
Practice Address - Phone:239-931-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist