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General NPI Number Information
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NPI Number | 1578712964
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Entity Type | Individual
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Provider Name | ANGIE CARLSON NACEY M.A., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1030 BROADVIEW BLVD
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City | BRACKENRIDGE
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State | PA
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Zip | 15014-1176
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Country | US
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Telephone | 724-224-8330
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Fax | 724-224-8510
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Provider Business Mailing Address
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Address Line | 1030 BROADVIEW BLVD
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City | BRACKENRIDGE
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State | PA
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Zip | 15014-1176
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Country | US
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Telephone | 724-224-8330
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Fax | 724-224-8510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT001004L
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License Number State | PA
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