Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 369885-3501 | UT |
NPI | 1003035429 |
---|---|
Provider Name | Mr. Mark Lynn Duke |
First Address | Sandy, UT 84092-5675 |
Second Address | Salt Lake City, UT 84111-1506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |