Provider Demographics
NPI:1538232442
Name:IANAKIEV, ANGELA HERNANDEZ (LCSW, CADC, PMH-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:HERNANDEZ
Last Name:IANAKIEV
Suffix:
Gender:F
Credentials:LCSW, CADC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43W043 CAMPTON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9435
Mailing Address - Country:US
Mailing Address - Phone:815-980-6740
Mailing Address - Fax:
Practice Address - Street 1:2700 KESLINGER RD STE B
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:307-653-2146
Practice Address - Fax:630-448-5169
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23399101YA0400X
IL1490154101041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210562004Medicare PIN