Provider Demographics
NPI:1124279062
Name:PRUESS, ANGELA ELLEN
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ELLEN
Last Name:PRUESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W156N8327 PILGRIM RD
Mailing Address - Street 2:#302
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3776
Mailing Address - Country:US
Mailing Address - Phone:262-251-1112
Mailing Address - Fax:262-251-1113
Practice Address - Street 1:W156N8327 PILGRIM RD
Practice Address - Street 2:302
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3776
Practice Address - Country:US
Practice Address - Phone:262-251-1112
Practice Address - Fax:262-251-1113
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI848124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist