Provider Demographics
NPI:1275849838
Name:DEADRICK, ANGELA LEE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:DEADRICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEE
Other - Last Name:DEADRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:249 5TH ST E
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175-1536
Practice Address - Country:US
Practice Address - Phone:507-629-3520
Practice Address - Fax:507-212-8260
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAP10-9701041C0700X
MN155731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical