Individual
ANGELA LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12920 SHAFER RD, LICKING, MO 65542-9413
(417) 260-4160
Mailing address
12920 SHAFER RD, LICKING, MO 65542-9413
(417) 260-4160
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
127669
MO
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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