Provider Demographics
NPI:1972749141
Name:TAPIA, ANGEL L (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:L
Last Name:TAPIA
Suffix:
Gender:M
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 1:9139 79TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2909
Mailing Address - Country:US
Mailing Address - Phone:718-308-7477
Mailing Address - Fax:
Practice Address - Street 1:9139 79TH ST
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2909
Practice Address - Country:US
Practice Address - Phone:718-308-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist