Provider Demographics
NPI:1861883704
Name:SWANSON, ANGELA (MA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LEWIS-SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13724 SE 272ND ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8018
Mailing Address - Country:US
Mailing Address - Phone:877-924-9718
Mailing Address - Fax:
Practice Address - Street 1:13724 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-8018
Practice Address - Country:US
Practice Address - Phone:877-924-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60166821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health