Provider Demographics
NPI:1467861740
Name:SMALL, ANGELA FARRAR
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FARRAR
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MENETTE
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:11600 100TH AVE NE
Mailing Address - Street 2:APT A12
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6501
Mailing Address - Country:US
Mailing Address - Phone:206-240-2114
Mailing Address - Fax:
Practice Address - Street 1:9757 NE JUANITA DR
Practice Address - Street 2:STE 214
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4291
Practice Address - Country:US
Practice Address - Phone:425-286-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601596201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical