Basic Information
| Provider Information | |||||||||
| NPI: | 1316458615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRITESMAN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | VIVIENNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | P.S.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1082 MAIN ST APT 205 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974774852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416530795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2145 CENTENNIAL PLZ | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414856340 | ||||||||
| FaxNumber: | 5419843124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2017 | ||||||||
| LastUpdateDate: | 10/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | THW2239 | OR | Y |
ID Information
| ID | Type | State | Issuer | Description | THW2239 | 01 | OR | TRADITIONAL HEALTH WORKER, PEER SUPPORT SPECIALIST ADULTS MENTAL HEALTH | OTHER |