Provider Demographics
NPI:1588823215
Name:PLOWHEAD, ANGELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:PLOWHEAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:FREGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5933
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 GOLDCREST AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-2295
Practice Address - Country:US
Practice Address - Phone:503-896-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR189220Medicare PIN
ORR189219Medicare PIN