Basic Information
| Provider Information | |||||||||
| NPI: | 1992909790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILEY | ||||||||
| FirstName: | ANGELINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW,LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WOODSTOCK DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450145233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133286004 | ||||||||
| FaxNumber: | 5138965682 | ||||||||
| Practice Location | |||||||||
| Address1: | 1490 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450113305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138967887 | ||||||||
| FaxNumber: | 5138965682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S0700043 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.