Provider Demographics
NPI:1205172541
Name:ANGELO, RACHEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ANGELO
Suffix:
Gender:F
Credentials: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:P.O. BOX 900
Mailing Address - Street 2:PENFIELD CENTRAL SCHOOL DISTRICT
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-249-5700
Mailing Address - Fax:585-248-8412
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022437-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist