Healthcare Provider Details

I. General information

NPI: 1962017772
Provider Name (Legal Business Name): ANGELA HELEN SUTTER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA HELEN RIVERA/ ESSLINGER

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-6733
US

IV. Provider business mailing address

3820 FAWCETT AVE
TACOMA WA
98418-6733
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4159
  • Fax: 253-968-4249
Mailing address:
  • Phone: 360-688-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61551587
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: