Individual
GENNIE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
Mailing address
555 E 4500 S, SUITE 150 C, SALT LAKE CITY, UT 84107-4533
(801) 288-0747
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
74547942506
UT
1041C0700X
Clinical Social Worker
74547943501
UT
Other
Enumeration date
05/28/2014
Last updated
11/12/2018
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