Healthcare Provider Details

I. General information

NPI: 1982958864
Provider Name (Legal Business Name): ANGELA LYN BIGELOW LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 W 9TH ST
WATERLOO IA
50702-5310
US

IV. Provider business mailing address

3641 KIMBALL AVE
WATERLOO IA
50702-5757
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-2893
  • Fax:
Mailing address:
  • Phone: 319-529-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001504
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: