Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11702999-3503 | UT |
NPI | 1003577545 |
---|---|
Provider Name | Rebekha Villalpando |
First Address | Ogden, UT 84401-3320 |
Second Address | Ogden, UT 84401-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2022 |
Last Update Date | 06/01/2022 |