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General NPI Number Information
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NPI Number | 1679543185
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Entity Type | Individual
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Provider Name | GINA MARIE ATTALLAH L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 2525 S LAKE PARK BLVD OPTUMHEALTH
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-8230
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Country | US
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Telephone | 801-982-3064
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Fax | 801-982-3159
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Provider Business Mailing Address
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Address Line | 1795 S 1700 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2970
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Country | US
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Telephone | 801-971-2845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 49721143501
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License Number State | UT
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