Provider Demographics
NPI:1679839765
Name:VANGILDER, ILENE J (LCSW)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:J
Last Name:VANGILDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 PINE HALL RD STE 225
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5107
Mailing Address - Country:US
Mailing Address - Phone:814-237-0001
Mailing Address - Fax:814-237-0116
Practice Address - Street 1:1951 PINE HALL RD STE 225
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5107
Practice Address - Country:US
Practice Address - Phone:814-237-0001
Practice Address - Fax:814-237-0116
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA126252104100000X
PACW0174101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical