Basic Information
| Provider Information | |||||||||
| NPI: | 1306490743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMPLE | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LANGE | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1221 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1812 24TH AVE W | ||||||||
| Address2: | |||||||||
| City: | SPENCER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 513012661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125803030 | ||||||||
| FaxNumber: | 7125803040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 096220 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.