Provider Demographics
NPI:1669683322
Name:WALTHER, ANGELA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-2671
Mailing Address - Country:US
Mailing Address - Phone:435-216-2170
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2671
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-2671
Practice Address - Country:US
Practice Address - Phone:435-216-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL69971041C0700X
UT5656278-35011041C0700X
COCSW.099277651041C0700X
SD60991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20103OtherAZ LCSW
UT5656278-3501OtherSTATE LICENSE
SD6099OtherSD LCSW LICENSE
COCSW.09927765OtherCO LCSW LICENSE
UTBRAATAOtherSBHC STAFF CODE
ORL6997OtherOR LCSW LICENSE