Provider Demographics
NPI:1346378478
Name:SWANK, ANGELIA J (LSCSW)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:J
Last Name:SWANK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S HOLLAND ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2096
Mailing Address - Country:US
Mailing Address - Phone:316-729-9965
Mailing Address - Fax:855-770-3988
Practice Address - Street 1:520 S HOLLAND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2096
Practice Address - Country:US
Practice Address - Phone:316-729-9965
Practice Address - Fax:855-770-3988
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS37181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS856680OtherBCBS
KS200440770AMedicaid
11758845OtherCAQH
KS200440770AMedicaid