Provider Demographics
NPI:1497341325
Name:BANGERTER, PATRICK A (BASW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:BANGERTER
Suffix:
Gender:M
Credentials:BASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1910
Mailing Address - Country:US
Mailing Address - Phone:253-345-9070
Mailing Address - Fax:
Practice Address - Street 1:415 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3415
Practice Address - Country:US
Practice Address - Phone:253-677-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health