=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275353773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA GIANOPOULOS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2024
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2811 S 102ND ST STE 220
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98168-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-525-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1926 CRESTVIEW DR
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60586-4123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-409-8727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 150104128
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------