Healthcare Provider Details

I. General information

NPI: 1952425043
Provider Name (Legal Business Name): HERTA AUDREY CRAWFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 1200 S STE 101
OREM UT
84058-6972
US

IV. Provider business mailing address

313 E 1200 S STE 101
OREM UT
84058-6972
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-0849
  • Fax: 801-221-0755
Mailing address:
  • Phone: 801-310-0849
  • Fax: 801-221-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140057-3501
License Number StateUT

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: