Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6827333-3503 | UT |
NPI | 1003091109 |
---|---|
Provider Name | Lisa Dawn Hendrickson |
First Address | St George, UT 84770-4505 |
Second Address | Beaver, UT 84713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 08/01/2008 |