Provider Demographics
NPI:1407514987
Name:WANGEN-HOCH, ERIC JOHN (SUDPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:WANGEN-HOCH
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 S MARCH POINT RD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8684
Mailing Address - Country:US
Mailing Address - Phone:360-588-2808
Mailing Address - Fax:
Practice Address - Street 1:8212 S MARCH POINT RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8684
Practice Address - Country:US
Practice Address - Phone:360-588-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61096243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)