Provider Demographics
NPI:1932127420
Name:CHENEY, ANGELA (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHENEY
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 1:600 DEMERS AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4599
Mailing Address - Country:US
Mailing Address - Phone:701-746-9341
Mailing Address - Fax:
Practice Address - Street 1:600 DEMERS AVE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4599
Practice Address - Country:US
Practice Address - Phone:701-746-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7H491CHMedicaid
NDCHE24777OtherBLUE CROSS/BLUE SHIELD ND
A004OtherWPS
ND18239Medicaid
MN7H491CHOtherBC/BS MN GRP # AW5G323DA
MN7H491CHMedicaid