Provider Demographics
NPI:1912390683
Name:DALLOLIO, ANGELA ELLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELLEN
Last Name:DALLOLIO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 E ADA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2725
Mailing Address - Country:US
Mailing Address - Phone:208-342-6300
Mailing Address - Fax:208-342-6301
Practice Address - Street 1:6550 W EMERALD ST STE 108
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8780
Practice Address - Country:US
Practice Address - Phone:208-342-6300
Practice Address - Fax:208-342-6301
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-37336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health