Provider Demographics
NPI:1033348305
Name:MCDANIEL, ANGELA MAE (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MAE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7570 W. 21ST ST. NORTH
Mailing Address - Street 2:BLDG 1050, STE E
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-285-0657
Mailing Address - Fax:316-260-9342
Practice Address - Street 1:555 N WOODLAWN ST STE 3105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3673
Practice Address - Country:US
Practice Address - Phone:316-681-1821
Practice Address - Fax:316-685-0768
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7519104100000X
KS46911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker