Provider Demographics
NPI:1699911073
Name:MCCUNE WIPER, ANGELA JEAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:MCCUNE WIPER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:952-994-0240
Mailing Address - Fax:
Practice Address - Street 1:7570 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3636
Practice Address - Country:US
Practice Address - Phone:952-994-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist