Most Relevant Information
Provider Data
| NPI Number: | 1003407578 |
| Provider Name: | ANGEL PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/28/2021 |
| Last Updated: | 04/25/2022 |
Provider Practice Location
6926 NE FOURTH PLAIN BLVD
VANCOUVER
WA
986617254
Practice Location Phone/Fax
| Phone: | 3609333000 |
| Fax: |
Provider Mailing Location
6926 NE FOURTH PLAIN BLVD
VANCOUVER
WA
986617254
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |