Provider Demographics
NPI:1518024918
Name:GILLENTINE, ANGELA MICHELE (AUD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELE
Last Name:GILLENTINE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 180-A
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7017
Mailing Address - Country:US
Mailing Address - Phone:972-747-1333
Mailing Address - Fax:972-747-1132
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 180-A
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:972-747-1333
Practice Address - Fax:972-747-1132
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51020237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7065317OtherAETNA
331023289OtherUNITED HEALTH CARE
TX528407OtherBLUECROSS AND BLUESHIELD
TX1469165-04Medicaid
TX33-1023289OtherFEDERAL TAX ID
TX7065317OtherAETNA