Individual
ANGELA CHIASSON WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 ROBYN ST, GRAY, LA 70359-4904
(985) 859-5266
Mailing address
8326 KELWOOD AVE, BATON ROUGE, LA 70806-4803
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003041054
DRIVERS LICENSE
—
Enumeration date
01/13/2020
Last updated
06/24/2020
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