Healthcare Provider Details

I. General information

NPI: 1982832796
Provider Name (Legal Business Name): ANGELA MARIA GULLETT M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TURNBERRY RD
CANTONMENT FL
32533-6818
US

IV. Provider business mailing address

401 TURNBERRY RD
CANTONMENT FL
32533-6818
US

V. Phone/Fax

Practice location:
  • Phone: 850-723-0040
  • Fax:
Mailing address:
  • Phone: 850-723-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP006784
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104877
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010370
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19600
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: