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General NPI Number Information
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NPI Number | 1316167737
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Entity Type | Individual
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Provider Name | ANGELA MICHELLE WATSON CADC APPLICANT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 400 NE 7TH ST
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City | GRESHAM
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State | OR
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Zip | 97030-5604
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Country | US
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Telephone | 503-661-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 39275 HOOD ST APT G
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City | SANDY
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State | OR
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Zip | 97055-9439
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Country | US
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Telephone | 503-668-5373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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