Provider Demographics
NPI:1316458615
Name:WRITESMAN, ANGELA VIVIENNE (PSS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:VIVIENNE
Last Name:WRITESMAN
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 MAIN ST APT 205
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4852
Mailing Address - Country:US
Mailing Address - Phone:541-653-0795
Mailing Address - Fax:
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2421
Practice Address - Country:US
Practice Address - Phone:541-485-6340
Practice Address - Fax:541-984-3124
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2239175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW2239OtherTRADITIONAL HEALTH WORKER, PEER SUPPORT SPECIALIST ADULTS MENTAL HEALTH