MEDICARE: ANGELA SCHWAB MS, LGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	5345194-3602	UT

General Provider Information

NPI Number	:	1508855214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SCHWAB MS, LGC

Provider Business Mailing Address
First Line	:	2000 CIRCLE OF HOPE DR
Second Line	:	ROOM 3145
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-585-5938
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CIRCLE OF HOPE DR
Second Line	:	ROOM 3145
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-585-5938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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