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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0004X | PSY.0002958 | CO | Y |   | Behavioral Health & Social Service Providers | Psychologist | Health |
No ID Information.