Provider Demographics
NPI:1376077990
Name:MARTI JEDINAK, ANGELA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MARTI JEDINAK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3471
Mailing Address - Country:US
Mailing Address - Phone:612-408-7975
Mailing Address - Fax:
Practice Address - Street 1:305 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3471
Practice Address - Country:US
Practice Address - Phone:612-408-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical