Healthcare Provider Details

I. General information

NPI: 1447984208
Provider Name (Legal Business Name): WENDY ELIZABETH LAMB CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N STATE ST
MOUNT PLEASANT UT
84647-1108
US

IV. Provider business mailing address

265 NORTH STATE STREET
MOUNT PLEASANT UT
84647-1108
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-2781
  • Fax: 435-462-0155
Mailing address:
  • Phone: 435-462-2781
  • Fax: 435-462-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number01565
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: