Basic Information
Provider Information
NPI: 1831348754
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREEN-DAHNKE
FirstName: ANGELA
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GREEN
OtherFirstName: ANGELA
OtherMiddleName: G
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PSY.D.
OtherLastNameType: 5
Mailing Information
Address1: 3701 S. BROADWAY
Address2:  
City: ENGLEWOOD
State: CO
PostalCode: 801133611
CountryCode: US
TelephoneNumber: 3033606276
FaxNumber: 3034675355
Practice Location
Address1: 15132 E. HAMPDEN AVE
Address2: SUITE G
City: AURORA
State: CO
PostalCode: 80014
CountryCode: US
TelephoneNumber: 3037626546
FaxNumber: 3037626500
Other Information
ProviderEnumerationDate: 09/16/2008
LastUpdateDate: 09/02/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TH0004XPSY.0002958COY Behavioral Health & Social Service ProvidersPsychologistHealth

No ID Information.


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