Provider Demographics
NPI:1851877591
Name:DICKMEYER, ANGELA LOUISE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:DICKMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2986
Mailing Address - Country:US
Mailing Address - Phone:507-327-9127
Mailing Address - Fax:
Practice Address - Street 1:5930 21ST AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2986
Practice Address - Country:US
Practice Address - Phone:507-327-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60841273390200000X
WA60716229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program