Organization
BLOOMSBURG UNIVERSITY SPEECH & HEARING CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD M ANGELO PH.D. (DIRECTOR OF CLINICAL SERVICES)
(570) 389-5380
Entity
Organization
Contact information
Practice address
400 E 2ND ST, CENTENNIAL HALL, BLOOMSBURG, PA 17815-1301
(570) 389-5380
(570) 389-5022
Mailing address
400 E. 2ND STREET, CENTENNIAL HALL, BLOOMSBURG, PA 17815
(570) 389-5380
(570) 389-5022
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
—
—
231HA2400X
Assistive Technology Practitioner Audiologist
D00617
PA
231HA2500X
Assistive Technology Supplier Audiologist
D00617
PA
235Z00000X
Speech-Language Pathologist
—
—
237600000X
Audiologist-Hearing Aid Fitter
D00617
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019428910002
—
PA
05
—
0019428910003
—
PA
01
—
50009520
CAPITAL BLUE CROSS
PA
01
—
50218
GEISINGER HEALTH PLAN
PA
Enumeration date
10/26/2006
Last updated
10/17/2007
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