Basic Information
| Provider Information | |||||||||
| NPI: | 1275789968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINKHAUS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUGGAN | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1175 CENTER DR | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983277733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539641559 | ||||||||
| FaxNumber: | 2539648495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 CENTER DR | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983277733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539641559 | ||||||||
| FaxNumber: | 2539648495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL00003871 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.