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General NPI Number Information
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NPI Number | 1619279270
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Entity Type | Individual
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Provider Name | ILENE GLANTZ MSW
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Gender | Female
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 11415 NE 128TH ST STE. 100
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City | KIRKLAND
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State | WA
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Zip | 98034-6314
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Country | US
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Telephone | 425-445-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 11415 NE 128TH ST STE 100
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City | KIRKLAND
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State | WA
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Zip | 98034-6314
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Country | US
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Telephone | 425-445-5692
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60019777
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License Number State | WA
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