Healthcare Provider Details

I. General information

NPI: 1295650976
Provider Name (Legal Business Name): ANGELINA ROSE GANZON PELIKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 RAILSCAPE VW APT 107
COLORADO SPRINGS CO
80921-4057
US

IV. Provider business mailing address

780 RAILSCAPE VW APT 107
COLORADO SPRINGS CO
80921-4057
US

V. Phone/Fax

Practice location:
  • Phone: 630-770-3918
  • Fax:
Mailing address:
  • Phone: 630-770-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001563
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: