Provider Demographics
NPI:1861269011
Name:SIMPSON, ANGELA GRACE DIMERCURIO (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE DIMERCURIO
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS/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:SOPRIS ELEMENTARY SCHOOL
Mailing Address - Street 2:1150 MT SOPRIS DR
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601
Mailing Address - Country:US
Mailing Address - Phone:970-379-3394
Mailing Address - Fax:
Practice Address - Street 1:SOPRIS ELEMENTARY SCHOOL
Practice Address - Street 2:1150 MT SOPRIS DR
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-379-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24367200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist