Basic Information
| Provider Information | |||||||||
| NPI: | 1285648261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARDELLA | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | IRWIN ARMY COMMUNITY HOSP., 650 HUEBNER ROAD | ||||||||
| Address2: | ATTN: MCXX-CLD-QM (CRED) CATHY TEIDEL | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664425037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397155 | ||||||||
| FaxNumber: | 7852397364 | ||||||||
| Practice Location | |||||||||
| Address1: | IRWIN ARMY COMMUNITY HOSP., 650 HUEBNER ROAD | ||||||||
| Address2: | ATTN: MCXX-CLD-QM (CRED) CATHY TIEDAL | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664425037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397155 | ||||||||
| FaxNumber: | 7852397364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3540 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.