Individual
MR. JOHN KEVIN ENNISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3195 S MAIN ST STE 180, SALT LAKE CITY, UT 84115-3790
(801) 867-7170
Mailing address
6905 S 1300 E # 221, COTTONWOOD HEIGHTS, UT 84047-1817
(801) 867-7170
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
122189-3501
UT
Other
Enumeration date
04/10/2006
Last updated
04/10/2019
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