Provider Demographics
NPI:1366616914
Name:DORFF, ANGELA (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:DORFF
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:STRAUBHAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:N47W27181 GREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-1837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N47W27181 GREEN HILL DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-1837
Practice Address - Country:US
Practice Address - Phone:262-695-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2725-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42573400Medicaid