Provider Demographics
NPI:1497007330
Name:HANSEN, ANGELA LEIGH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEIGH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LIEGH
Other - Last Name:GARLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:403 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1610
Mailing Address - Country:US
Mailing Address - Phone:208-887-1911
Mailing Address - Fax:208-895-8049
Practice Address - Street 1:403 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1610
Practice Address - Country:US
Practice Address - Phone:208-887-1911
Practice Address - Fax:208-895-8049
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-341041041C0700X
WYLCSW-8841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical