Provider Demographics
NPI:1376086124
Name:GELDER, ANGELA J
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:J
Last Name:GELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18124 SUNSHINE LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-7528
Mailing Address - Country:US
Mailing Address - Phone:360-508-4958
Mailing Address - Fax:
Practice Address - Street 1:18124 SUNSHINE LN SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-7528
Practice Address - Country:US
Practice Address - Phone:360-508-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103K00000XMedicaid