Healthcare Provider Details

I. General information

NPI: 1457564650
Provider Name (Legal Business Name): WENDY MAE LLOYD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 S 750 E
BOUNTIFUL UT
84010-4216
US

IV. Provider business mailing address

2246 S 750 E
BOUNTIFUL UT
84010-4216
US

V. Phone/Fax

Practice location:
  • Phone: 801-718-4964
  • Fax: 801-298-4091
Mailing address:
  • Phone: 801-718-4964
  • Fax: 801-298-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number341623 3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: