Provider Demographics
NPI:1417341306
Name:ALEXANDER, ANGELA
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 N CLYBOURN AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8269
Mailing Address - Country:US
Mailing Address - Phone:773-270-0469
Mailing Address - Fax:
Practice Address - Street 1:2865 N CLYBOURN AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-8269
Practice Address - Country:US
Practice Address - Phone:773-270-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP1600X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral