Provider Demographics
NPI:1699132118
Name:JABRE, ANGELE D (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELE
Middle Name:D
Last Name:JABRE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 COTE DU RHONE WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4470
Mailing Address - Country:US
Mailing Address - Phone:317-607-2135
Mailing Address - Fax:
Practice Address - Street 1:5174 COTE DU RHONE WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4470
Practice Address - Country:US
Practice Address - Phone:317-607-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4774235Z00000X
OHSP.10785235Z00000X
FLSA12775235Z00000X
IN22004444A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist