Provider Demographics
NPI:1851770887
Name:TEETERS, ANGELIQUE R (PSYD)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:R
Last Name:TEETERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 VICTORY PKWY
Mailing Address - Street 2:STE. 500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2839
Mailing Address - Country:US
Mailing Address - Phone:513-221-2330
Mailing Address - Fax:
Practice Address - Street 1:2330 VICTORY PKWY
Practice Address - Street 2:STE. 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2839
Practice Address - Country:US
Practice Address - Phone:513-221-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7280103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist