Provider Demographics
NPI:1477191526
Name:SCIACCA, ANGELA THERESA (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:THERESA
Last Name:SCIACCA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:THERESA
Other - Last Name:SCIACCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:2305 E 13TH ST APT U
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4187
Mailing Address - Country:US
Mailing Address - Phone:815-919-5888
Mailing Address - Fax:
Practice Address - Street 1:2305 E 13TH ST APT U
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4187
Practice Address - Country:US
Practice Address - Phone:815-919-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-19-81634106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician