Provider Demographics
NPI:1508275637
Name:BRACKHAHN, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRACKHAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:BINGEN
Mailing Address - State:WA
Mailing Address - Zip Code:98605-0323
Mailing Address - Country:US
Mailing Address - Phone:541-490-4377
Mailing Address - Fax:
Practice Address - Street 1:419 E 7TH ST
Practice Address - Street 2:STE. 207
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2676
Practice Address - Country:US
Practice Address - Phone:541-490-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor