Provider Demographics
NPI:1518385459
Name:LEASE, ANGELINA STOMLUND (BCBA-LBA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:STOMLUND
Last Name:LEASE
Suffix:
Gender:F
Credentials:BCBA-LBA
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:STROMLUND
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA-LBA
Mailing Address - Street 1:1205 35TH STREET PL SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4400
Mailing Address - Country:US
Mailing Address - Phone:253-339-6094
Mailing Address - Fax:253-251-0716
Practice Address - Street 1:1205 35TH STREET PL SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4400
Practice Address - Country:US
Practice Address - Phone:253-339-6094
Practice Address - Fax:253-251-0716
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst