Individual
ANGELA ANTONIA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
1003 E MAIN ST STE 104, MEDFORD, OR 97504
(541) 779-1282
(541) 608-2888
Mailing address
1003 E MAIN ST STE 104, MEDFORD, OR 97504-7140
(541) 779-1282
(541) 608-2888
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
THW000003687
OR
175T00000X
Peer Specialist
Primary
THW000003687
OR
Other
Enumeration date
02/01/2016
Last updated
01/28/2020
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