Healthcare Provider Details

I. General information

NPI: 1386960391
Provider Name (Legal Business Name): ANGELA LYNN VREDEVELD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11497 SPRINGFIELD PIKE SUITE 5
CINCINNATI OH
45246-3551
US

IV. Provider business mailing address

11497 SPRINGFIELD PIKE SUITE 5
CINCINNATI OH
45246-3551
US

V. Phone/Fax

Practice location:
  • Phone: 513-772-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6653
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: