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1497235865 NPI number — ANGELA LECIA WALDEN PHD

NPI Number: 1497235865
Health Care Provider/Practitioner: ANGELA LECIA WALDEN PHD

Information about “1497235865” NPI (ANGELA LECIA WALDEN PHD) exists in 1497235865 in HTML format HTML  |  1497235865 in plain Text format TXT  |  1497235865 in PDF (Portable Document Format) PDF  |  1497235865 in an XML format XML  formats.

NPI Number : 1497235865 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497235865",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALDEN",
    "FirstName": "ANGELA",
    "MiddleName": "LECIA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2125 W BOWLER ST FL 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60612-4201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-748-3586",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1747 W ROOSEVELT RD # WROB155",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60608-1264",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-996-9507",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/15/2018",
    "LastUpdateDate": "08/15/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "071.009769",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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