Provider Demographics
NPI:1194060178
Name:PHILLIPS, ANGELA LEAH (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEAH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9010
Mailing Address - Country:US
Mailing Address - Phone:206-535-6292
Mailing Address - Fax:206-356-1151
Practice Address - Street 1:10740 MERIDIAN AVE N
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:206-535-6292
Practice Address - Fax:206-356-1151
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1175171041C0700X
390200000X
WASC604293781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC60429378OtherWASHINGTON STATE DEPARTMENT OF HEALTH
CALCSW117517OtherCA STATE