Healthcare Provider Details

I. General information

NPI: 1093291858
Provider Name (Legal Business Name): ANGELINA LESLIE ROMERO M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 THATCHER ST
BROCKTON MA
02302-3949
US

IV. Provider business mailing address

PO BOX 28
PADUCAH KY
42002-0028
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-5834
  • Fax:
Mailing address:
  • Phone: 270-217-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP78640
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number167285
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.028717
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2026-0009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: