MEDICARE: MS. ANGELA WOOTEN M.S., CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	50252	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780604942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA WOOTEN M.S., CCC-A

Provider Business Mailing Address
First Line	:	4403 MENCHACA RD STE E
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1646
Country	:	US
Telephone Number	:	512-444-8684
Fax Number	:	512-444-8697

Provider Business Practice Location Address
First Line	:	4403 MENCHACA RD STE E
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1646
Country	:	US
Telephone Number	:	512-444-8684
Fax Number	:	512-444-8697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/26/2022

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