Provider Demographics
NPI:1619130606
Name:DRYDEN, ANGELA JENNETTE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JENNETTE
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SE WEEKS CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1708
Mailing Address - Country:US
Mailing Address - Phone:971-235-4309
Mailing Address - Fax:
Practice Address - Street 1:120 E ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2406
Practice Address - Country:US
Practice Address - Phone:971-235-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist