Provider Demographics
NPI:1053803106
Name:STRADER, ANGELA (CSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STRADER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 575746
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-5746
Mailing Address - Country:US
Mailing Address - Phone:801-652-7012
Mailing Address - Fax:
Practice Address - Street 1:1425 S 700 E # 102
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-2125
Practice Address - Country:US
Practice Address - Phone:801-652-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 175T00000X
UT12894556-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health