Provider Demographics
NPI:1609177237
Name:SEDENO, ANGELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:SEDENO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S HAMILTON AVE
Mailing Address - Street 2:MEDICAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4207
Mailing Address - Country:US
Mailing Address - Phone:773-919-9116
Mailing Address - Fax:
Practice Address - Street 1:1100 S HAMILTON AVE
Practice Address - Street 2:MEDICAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4207
Practice Address - Country:US
Practice Address - Phone:312-433-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008006103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily