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General NPI Number Information
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NPI Number | 1396152484
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Entity Type | Individual
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Provider Name | ANGELA TESS
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 3535 N BELL SCHOOL RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6624
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Country | US
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Telephone | 779-696-9400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1567
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City | ROCKFORD
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State | IL
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Zip | 61110-0067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 246000116
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License Number State | IL
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