Provider Demographics
NPI:1982238820
Name:GUTEKUNST, ANGELIQUE L (MS)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:L
Last Name:GUTEKUNST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-7722
Mailing Address - Country:US
Mailing Address - Phone:610-730-0996
Mailing Address - Fax:
Practice Address - Street 1:3708 FREEMANSBURG AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-6512
Practice Address - Country:US
Practice Address - Phone:610-730-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health