1376772384 NPI number — MS. ANGELA RAE KOLKMAN WHIDDEN MSW, LISW-S

Table of content: MS. ANGELA RAE KOLKMAN WHIDDEN MSW, LISW-S (NPI 1376772384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376772384 NPI number — MS. ANGELA RAE KOLKMAN WHIDDEN MSW, LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHIDDEN
Provider First Name:
ANGELA
Provider Middle Name:
RAE KOLKMAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOLKMAN
Provider Other First Name:
ANGELA
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LISW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376772384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17825 BALDWIN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-269-3487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 CARNEGIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-952-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2009

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: 1041C0700X , with the licence number:  S.1000340 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: I.1200522 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1376772384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".