Healthcare Provider Details

I. General information

NPI: 1518897966
Provider Name (Legal Business Name): ANGELINE WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

IV. Provider business mailing address

488 TIFFANY DR
HASTINGS MN
55033-3980
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352001243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: