Provider Demographics
NPI:1902033673
Name:WELLS, ANGELA C (BSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:WELLS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 W HICKORY ST
Mailing Address - Street 2:APT 1
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3437
Mailing Address - Country:US
Mailing Address - Phone:309-558-8666
Mailing Address - Fax:
Practice Address - Street 1:1229 W 8TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1331
Practice Address - Country:US
Practice Address - Phone:563-322-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker