Provider Demographics
NPI:1174791479
Name:BANGE, ABBY LYNN (MS, CN, RD MHCA)
Entity type:Individual
Prefix:MS
First Name:ABBY
Middle Name:LYNN
Last Name:BANGE
Suffix:
Gender:F
Credentials:MS, CN, RD MHCA
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:LYNN
Other - Last Name:BANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CN
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-1043
Mailing Address - Country:US
Mailing Address - Phone:206-372-2210
Mailing Address - Fax:
Practice Address - Street 1:13 EVANS RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9729
Practice Address - Country:US
Practice Address - Phone:206-372-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60199461101YM0800X
WANU60058318133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health