Healthcare Provider Details

I. General information

NPI: 1184140345
Provider Name (Legal Business Name): ANNA KARYN LACY WHISLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2017
Last Update Date: 08/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 N MAIN ST STE 203
LOGAN UT
84321-6204
US

IV. Provider business mailing address

523 N 750 E
HYDE PARK UT
84318-3357
US

V. Phone/Fax

Practice location:
  • Phone: 435-915-6777
  • Fax:
Mailing address:
  • Phone: 435-915-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: