Provider Demographics
NPI:1275789968
Name:BRINKHAUS, ANGELA MARY (SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:BRINKHAUS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARY
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1175 CENTER DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-7733
Mailing Address - Country:US
Mailing Address - Phone:253-964-1559
Mailing Address - Fax:253-964-8495
Practice Address - Street 1:1175 CENTER DR
Practice Address - Street 2:SUITE 160
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-7733
Practice Address - Country:US
Practice Address - Phone:253-964-1559
Practice Address - Fax:253-964-8495
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist