Provider Demographics
NPI:1942314091
Name:WIGHTMAN, ANGELINE EVELYN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINE
Middle Name:EVELYN
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:ANGELINE
Other - Middle Name:EVELYN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4308 76TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3720
Mailing Address - Country:US
Mailing Address - Phone:425-349-7326
Mailing Address - Fax:425-349-7366
Practice Address - Street 1:4308 76TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3720
Practice Address - Country:US
Practice Address - Phone:425-349-7326
Practice Address - Fax:425-349-7366
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health