Provider Demographics
NPI:1992928998
Name:WALEN, ANGELA (FP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WALEN
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FP
Mailing Address - Street 1:42432 N ACADIA WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2763
Mailing Address - Country:US
Mailing Address - Phone:623-551-2309
Mailing Address - Fax:
Practice Address - Street 1:42432 N ACADIA WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-2763
Practice Address - Country:US
Practice Address - Phone:623-551-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ156614Medicaid