Provider Demographics
NPI:1780111880
Name:MCVICKER, ANGELA LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LYNN
Last Name:MCVICKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:CABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:23293 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5808
Mailing Address - Country:US
Mailing Address - Phone:216-292-7170
Mailing Address - Fax:
Practice Address - Street 1:23293 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5808
Practice Address - Country:US
Practice Address - Phone:216-292-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist