Provider Demographics
NPI:1700549193
Name:DENIKE, ANGELICIA LOUISE
Entity Type:Individual
Prefix:
First Name:ANGELICIA
Middle Name:LOUISE
Last Name:DENIKE
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 1:3100 NW BUCKLIN HILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8363
Mailing Address - Country:US
Mailing Address - Phone:360-377-2222
Mailing Address - Fax:
Practice Address - Street 1:3100 BUCKLIN HILL RD NW
Practice Address - Street 2:SUITE 215
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician