Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 10376859-3501 | UT |
NPI | 1003344946 |
---|---|
Provider Name | Jalynn Porter |
First Address | Spanish Fork, UT 84660-5744 |
Second Address | Spanish Fork, UT 84660-5744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 23/03/2021 |