Healthcare Provider Details

I. General information

NPI: 1730484494
Provider Name (Legal Business Name): ANGELA ELIZABETH MIELKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S CHERRY ST SUITE 400
DENVER CO
80246-2699
US

IV. Provider business mailing address

950 S CHERRY ST SUITE 400
DENVER CO
80246-2699
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-5396
  • Fax:
Mailing address:
  • Phone: 720-295-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number000329488
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0003566
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: