Provider Demographics
NPI:1699921346
Name:WALL, ANGELA K (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:WALL
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 1:11708 N COLLEGE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5642
Mailing Address - Country:US
Mailing Address - Phone:317-569-0086
Mailing Address - Fax:
Practice Address - Street 1:11708 N COLLEGE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5642
Practice Address - Country:US
Practice Address - Phone:317-569-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003641A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist