Healthcare Provider Details

I. General information

NPI: 1508855214
Provider Name (Legal Business Name): ANGELA SCHWAB MS, LGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR ROOM 3145
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

2000 CIRCLE OF HOPE DR ROOM 3145
SALT LAKE CITY UT
84112-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-5938
  • Fax:
Mailing address:
  • Phone: 801-585-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number5345194-3602
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: