Provider Demographics
NPI:1386184885
Name:CLOSE, ANGELA CLEARY
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CLEARY
Last Name:CLOSE
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 1:475 RAY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2307
Mailing Address - Country:US
Mailing Address - Phone:408-203-3779
Mailing Address - Fax:
Practice Address - Street 1:1836 FREMONT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2537
Practice Address - Country:US
Practice Address - Phone:541-482-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst