Individual
MRS. MARTHA BURKETT FALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4334 TIDWELL ST, KEARNS, UT 84118-5231
(801) 244-2426
Mailing address
4334 TIDWELL ST, KEARNS, UT 84118-5231
(801) 244-2426
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
56599619-3502
UT
1041C0700X
Clinical Social Worker
Primary
5659619-3501
UT
Other
Enumeration date
05/28/2006
Last updated
06/04/2014
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