Provider Demographics
NPI:1356428486
Name:DAMRON, ANGELA E (MA, CCC/A)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:DAMRON
Suffix:
Gender:F
Credentials:MA, CCC/A
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:E
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 W MARKET ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3324
Mailing Address - Country:US
Mailing Address - Phone:330-869-9911
Mailing Address - Fax:
Practice Address - Street 1:3200 W MARKET ST STE 108
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3324
Practice Address - Country:US
Practice Address - Phone:330-869-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105418Medicaid
OHH058891Medicare UPIN
OH0105418Medicaid
4166211Medicare PIN