Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 112005-3501 | UT |
NPI | 1003106535 |
---|---|
Provider Name | Dr. Joel L Millard |
First Address | Salt Lake City, UT 84111-3806 |
Second Address | Salt Lake City, UT 84111-3806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 18/04/2011 |