Angellun Vanessa Wilder, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2176 Issued in LA

Practice address

3004 Knight St BLDG 6
Shreveport, LA 71105-2502

Phone

(318) 603-6874

NPI assigned

May 2, 2008

Last updated

May 2, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Angela Vanessa Wilder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209686400000",
    "number": "1346416096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4443 PINES RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711198505",
            "telephone_number": "318-631-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 KNIGHT ST BLDG 6",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052502",
            "telephone_number": "318-603-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "ANGELLUN",
        "middle_name": "VANESSA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2008-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "2176",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "LA",
            "license": "2176",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "WILDER",
            "middle_name": "VANESSA",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elbony Rosha Wilcott
• Charles Timothy Wilcox, L.P.C., LMFT
• Johnessa Wilcox
• Elizabeth S. Wild, MD, MS
• Jessica Anne Wilden, MD
• Rebecca J Wilder, DROT, LOTR
• Nicole Wiley
• Kenneth I Wilhite, RPH
• Arzeria L Wilkerson
• Eunice Wilkerson

• Clinical Social Worker in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Clinical Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.