Healthcare Provider Details

I. General information

NPI: 1639576630
Provider Name (Legal Business Name): ANGELA DAWN KLEPTZ M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LIBRARY BLVD
GREENWOOD IN
46142-1567
US

IV. Provider business mailing address

6783 S SHIELDS RIDGE RD
BLOOMINGTON IN
47401-9018
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-9965
  • Fax:
Mailing address:
  • Phone: 317-345-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004911A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: