Provider Demographics
NPI:1962926485
Name:KLINGENSMITH, ANGELA (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KLINGENSMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 JADWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4217
Mailing Address - Country:US
Mailing Address - Phone:509-214-1894
Mailing Address - Fax:509-464-6597
Practice Address - Street 1:719 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4217
Practice Address - Country:US
Practice Address - Phone:509-214-1894
Practice Address - Fax:509-464-6597
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3182103T00000X, 103TC0700X
WAAP60098621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical