Provider Demographics
NPI:1134332851
Name:TRAVERS, ANGELA D (MS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:T
Other - Last Name:DENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4627 KNIGHT PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-4924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4627 KNIGHT PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-4924
Practice Address - Country:US
Practice Address - Phone:660-429-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2851-154235Z00000X
VA2202006421235Z00000X
MO2008012494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42582000Medicaid