Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11169782-3502 | UT |
NPI | 1003413964 |
---|---|
Provider Name | Michelle Anklan |
First Address | Murray, UT 84107-2249 |
Second Address | Salt Lake City, UT 84115-5336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 05/10/2020 |