Provider Demographics
NPI:1336657543
Name:RAMIREZ, ANGELA LEE ERBST (IADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE ERBST
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEE
Other - Last Name:ERBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IADC
Mailing Address - Street 1:12160 S UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-9537
Mailing Address - Country:US
Mailing Address - Phone:563-326-1150
Mailing Address - Fax:563-333-9108
Practice Address - Street 1:12160 S UTAH AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-9537
Practice Address - Country:US
Practice Address - Phone:563-326-1150
Practice Address - Fax:563-333-9108
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08235101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor