1265706972 NPI number — ANGELA REED CLINICAL SUPERVISOR

Table of content: ANGELA REED CLINICAL SUPERVISOR (NPI 1265706972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265706972 NPI number — ANGELA REED CLINICAL SUPERVISOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL SUPERVISOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265706972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8383 GREENWAY BLVD STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53562-4659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-444-1717
Provider Business Mailing Address Fax Number:
608-465-4021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8383 GREENWAY BLVD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53562-4659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-444-1717
Provider Business Practice Location Address Fax Number:
608-465-4021
Provider Enumeration Date:
02/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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