Provider Demographics
NPI:1548433659
Name:WENDEBORN, ANGELA (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WENDEBORN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-802-9779
Mailing Address - Fax:713-802-2289
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:SUITE 234
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-802-9779
Practice Address - Fax:713-802-2289
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51083231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
51083OtherAUDIOLOGY LICENSE NUMBER
00575UOtherMEDICARE GROUP NUMBER
1184707788OtherGROUP NPI