Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 12377650-3501 | UT |
N | 1041C0700X | Clinical Social Worker | 25733 | MN |
NPI | 1003255324 |
---|---|
Provider Name | Ms. Annalise John |
First Address | West Valley City, UT 84120-2815 |
Second Address | West Valley City, UT 84120-2815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 21/08/2021 |