Provider Demographics
NPI:1760848733
Name:DAGNACHEW, ANGELA (LISW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DAGNACHEW
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST STE 506
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1418
Mailing Address - Country:US
Mailing Address - Phone:515-257-3513
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST STE 506
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1418
Practice Address - Country:US
Practice Address - Phone:515-257-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0079721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical