Healthcare Provider Details

I. General information

NPI: 1912362187
Provider Name (Legal Business Name): ANGELA MYERS M.S., M.EDU.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 W FAIDLEY AVE
GRAND ISLAND NE
68803-4199
US

IV. Provider business mailing address

1018 N HASTINGS AVE
HASTINGS NE
68901-3845
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-2333
  • Fax:
Mailing address:
  • Phone: 308-390-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1694
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14109899
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: