Provider Demographics
NPI:1508068842
Name:RAYMOND, ANGELA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:BUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS SOCIOLOGY
Mailing Address - Street 1:17497 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-4509
Mailing Address - Country:US
Mailing Address - Phone:715-288-5828
Mailing Address - Fax:
Practice Address - Street 1:323 E LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1502
Practice Address - Country:US
Practice Address - Phone:715-537-9921
Practice Address - Fax:715-537-1607
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513-126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI513-126OtherTRAINING CERT. FOR LPC
WI53717100Medicaid