Individual
ANGELIQUE NICOLE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CGG61649106
Contact information
Practice address
15 S GRADY WAY STE 245, RENTON, WA 98057-3209
(206) 679-8291
(206) 274-6252
Mailing address
15 S GRADY WAY STE 245, RENTON, WA 98057-3209
(206) 679-8291
(206) 274-6252
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG61649160
WA
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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