Provider Demographics
NPI:1902256654
Name:DUBRO, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DUBRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41677 215TH ST
Mailing Address - Street 2:
Mailing Address - City:IROQUOIS
Mailing Address - State:SD
Mailing Address - Zip Code:57353-7708
Mailing Address - Country:US
Mailing Address - Phone:605-546-8571
Mailing Address - Fax:
Practice Address - Street 1:41677 215TH ST
Practice Address - Street 2:
Practice Address - City:IROQUOIS
Practice Address - State:SD
Practice Address - Zip Code:57353-7708
Practice Address - Country:US
Practice Address - Phone:605-546-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD089-LIMITED235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist