MEDICARE: MRS. ANGELA JUNE MAGOON M.S.CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12055132	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174790828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA JUNE MAGOON M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	3442 MAPLE CIR
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-3431
Country	:	US
Telephone Number	:	303-523-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	3442 MAPLE CIR
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-3431
Country	:	US
Telephone Number	:	303-523-9165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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