Provider Demographics
NPI:1144075557
Name:LOVE, ANGELA ANNE (MS,CCC/SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNE
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CANVASBACK CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-8848
Mailing Address - Country:US
Mailing Address - Phone:615-604-6926
Mailing Address - Fax:
Practice Address - Street 1:211 FORTRESS BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5593
Practice Address - Country:US
Practice Address - Phone:615-410-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist