Provider Demographics
NPI:1144491721
Name:BOONIE, ANGELA GRACE (AUD, CCC-A, FAAA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:BOONIE
Suffix:
Gender:F
Credentials:AUD, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2847
Mailing Address - Country:US
Mailing Address - Phone:814-591-9542
Mailing Address - Fax:
Practice Address - Street 1:200 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-641-4327
Practice Address - Fax:814-641-7104
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006006231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031336OtherHIGHMARK BLUE SHIELD
PA125959MT4Medicare PIN