Provider Demographics
NPI:1427739325
Name:ANGCO, KYLA JACEE (PSS)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:JACEE
Last Name:ANGCO
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:ATKINS
Other - Middle Name:JASON
Other - Last Name:ANGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:565 UNION ST NE STE 205
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2418
Mailing Address - Country:US
Mailing Address - Phone:503-991-5522
Mailing Address - Fax:
Practice Address - Street 1:565 UNION ST NE STE 205
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2418
Practice Address - Country:US
Practice Address - Phone:503-991-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist