Provider Demographics
NPI:1720362098
Name:WASCO COUNTY STUDENT ASISTANCE PROGRAM, LLC
Entity Type:Organization
Organization Name:WASCO COUNTY STUDENT ASISTANCE PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-993-7270
Mailing Address - Street 1:317 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1807
Mailing Address - Country:US
Mailing Address - Phone:541-993-7270
Mailing Address - Fax:541-296-1080
Practice Address - Street 1:317 W 4TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1807
Practice Address - Country:US
Practice Address - Phone:541-993-7270
Practice Address - Fax:541-296-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health