Organization
MARY ALICE CUNNINGHAM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ALICE STODDARD CUNNINGHAM LCSW (CEO)
(801) 842-9800
Entity
Organization
Contact information
Practice address
7971 PIONEER ST, MIDVALE, UT 84047-7418
(801) 842-9800
Mailing address
7971 PIONEER ST, MIDVALE, UT 84047-7418
(801) 842-9800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
323492-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093742058
LCSW
UT
Enumeration date
01/23/2007
Last updated
08/22/2020
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