Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 118012913502 | UT |
N | 1041C0700X | Clinical Social Worker | 118012913502 | UT |
NPI | 1003573353 |
---|---|
Provider Name | Rebecca Jane Mcnairy |
First Address | Orem, UT 84097-4404 |
Second Address | Orem, UT 84057-5207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2021 |
Last Update Date | 22/11/2021 |