Provider Demographics
NPI:1972571925
Name:STANGELAND, MARCIA DENISE (MED)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:DENISE
Last Name:STANGELAND
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-1976
Mailing Address - Country:US
Mailing Address - Phone:509-375-1374
Mailing Address - Fax:
Practice Address - Street 1:320 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2771
Practice Address - Country:US
Practice Address - Phone:509-531-1207
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health