Provider Demographics
NPI:1972862019
Name:LECLAIR, ANGELA CARROLL (ND)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CARROLL
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11049 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8228
Mailing Address - Country:US
Mailing Address - Phone:206-616-6768
Mailing Address - Fax:206-616-8188
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356422
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6420
Practice Address - Country:US
Practice Address - Phone:206-616-6768
Practice Address - Fax:206-616-8188
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000667175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath