Provider Demographics
NPI:1922331883
Name:VANDEVENTER, ANGELA M (SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:FREDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8019 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4227
Mailing Address - Country:US
Mailing Address - Phone:913-963-3715
Mailing Address - Fax:
Practice Address - Street 1:8019 ALDEN ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4227
Practice Address - Country:US
Practice Address - Phone:913-963-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2658235Z00000X
MO2006010653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist