Provider Demographics
NPI:1376772384
Name:WHIDDEN, ANGELA RAE KOLKMAN (MSW, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RAE KOLKMAN
Last Name:WHIDDEN
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:RAE
Other - Last Name:KOLKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW
Mailing Address - Street 1:17825 BALDWIN PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1004
Mailing Address - Country:US
Mailing Address - Phone:808-269-3487
Mailing Address - Fax:
Practice Address - Street 1:3500 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2641
Practice Address - Country:US
Practice Address - Phone:216-952-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.10003401041C0700X
OHI.12005221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1376772384Medicaid