Doctor Name: | MRS. ANGELA RAE DEROUIN |
NPI Number: | 1760710693 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 3231-154 |
Business Practice Address: | N84w17049 Menomonee Ave Menomonee Falls, WI - 530512701 |
Business Phone Number: | 2622551180 |
Business Fax Number: | 2622551638 |
Mailing Address: | N84w17049 Menomonee Ave, MENOMONEE FALLS |
State: | WI |
Postal Code: | 530512701 |
Phone Number: | 2622551180 |
Fax Number: | 2622551638 |
NPI Enumeration Date: | 12/04/2009 |
NPI Last Update Date: | 04/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3231-154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |