Provider Demographics
NPI:1386960391
Name:VREDEVELD, ANGELA LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:VREDEVELD
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 1:11497 SPRINGFIELD PIKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11497 SPRINGFIELD PIKE
Practice Address - Street 2:SUITE 5
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3551
Practice Address - Country:US
Practice Address - Phone:513-772-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6653103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical