Individual
CHRISTINA ELLWANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1325 N MAIN ST, BOUNTIFUL, UT 84010-6089
(801) 895-2575
Mailing address
4503 W RIPPLE DR, WEST JORDAN, UT 84088-2328
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
105665263501-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10566526-3501
PROFESSIONAL LICENSE, LCSW
UT
Enumeration date
05/17/2022
Last updated
05/17/2022
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