Provider Demographics
NPI:1457535130
Name:HEISS, ANGELA JOLEEN (MA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JOLEEN
Last Name:HEISS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:DALE
Other - Last Name:CARTWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1259 W SMITH ST APT E101
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5203
Mailing Address - Country:US
Mailing Address - Phone:253-486-6629
Mailing Address - Fax:
Practice Address - Street 1:1259 W SMITH ST APT E101
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5203
Practice Address - Country:US
Practice Address - Phone:253-486-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00021672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00021672Medicaid