MEDICARE: ANGELIQUE BERNAL M.A., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	0

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

General Provider Information

NPI Number	:	1891248100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE BERNAL M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	8101 WILLOW BRANCH DR
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-7039
Country	:	US
Telephone Number	:	704-577-1951
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 WILLOW BRANCH DR
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-7039
Country	:	US
Telephone Number	:	704-577-1951
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	10/06/2021

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