Healthcare Provider Details

I. General information

NPI: 1851210553
Provider Name (Legal Business Name): SOPHIE ADRIANNA AGBAYANI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 52ND AVE
MOLINE IL
61265-6366
US

IV. Provider business mailing address

910 E LOCUST ST APT 4
DAVENPORT IA
52803-3142
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-2900
  • Fax:
Mailing address:
  • Phone: 563-949-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150129294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: