Provider Demographics
NPI:1669826087
Name:GASS, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:GASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NW HILL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2949
Mailing Address - Country:US
Mailing Address - Phone:541-788-7846
Mailing Address - Fax:
Practice Address - Street 1:416 NW HILL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2949
Practice Address - Country:US
Practice Address - Phone:541-788-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health