Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003581703 |
---|---|
Provider Name | Wendy Delacruz |
First Address | Spanish Fork, UT 84660-8003 |
Second Address | Spanish Fork, UT 84660-8003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 22/08/2021 |