Individual
RUDY JOHANSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
500 FOOTHILL DR, 116HO, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2507
Mailing address
1470 S 235 W, OREM, UT 84058-7370
(801) 225-3532
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
134481-3501
UT
Other
Enumeration date
05/12/2006
Last updated
07/08/2007
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