Individual
ANGELA MARIE GILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
17434 STATE ROAD 23 STE 205, SOUTH BEND, IN 46635-1743
(574) 742-1114
Mailing address
17434 STATE ROAD 23 STE 205, SOUTH BEND, IN 46635-1743
(574) 742-1114
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22007156A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22007156A
SPEECH LANGUAGE PATHOLOGIST
IN
Enumeration date
10/15/2021
Last updated
10/15/2021
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