Provider Demographics
NPI:1619279270
Name:GLANTZ, ILENE (MSW)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 NE 128TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6314
Mailing Address - Country:US
Mailing Address - Phone:425-445-5692
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST
Practice Address - Street 2:STE. 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-445-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600197771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical