Provider Demographics
NPI:1760973697
Name:HAAS, ANGELA (CDS,CSA,CDP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:CDS,CSA,CDP
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 220053
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-277-0851
Mailing Address - Fax:
Practice Address - Street 1:1361 CHILDRESS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3451
Practice Address - Country:US
Practice Address - Phone:314-277-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G200131024OtherCDP