Healthcare Provider Details

I. General information

NPI: 1104751494
Provider Name (Legal Business Name): ANGELA DEAN-BAHAM M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 BIRDSALL AVE
OAKLAND CA
94619-2619
US

IV. Provider business mailing address

3366 BIRDSALL AVE
OAKLAND CA
94619-2619
US

V. Phone/Fax

Practice location:
  • Phone: 510-681-6859
  • Fax:
Mailing address:
  • Phone: 510-681-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP39811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: