Provider Demographics
NPI:1740496868
Name:ANGEL, LINDA MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:ANGEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1222
Mailing Address - Country:US
Mailing Address - Phone:262-634-2391
Mailing Address - Fax:262-634-5342
Practice Address - Street 1:420 SEVENTH ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1222
Practice Address - Country:US
Practice Address - Phone:262-634-2391
Practice Address - Fax:262-634-5342
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8101211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467419200OtherNPI AGENCY
WI39696400Medicaid