Individual
ANGELA RAE HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
N1184 S WHITE RIVER RD, WAUTOMA, WI 54982-9021
(715) 209-1253
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13069232-3501
UT
1041C0700X
Clinical Social Worker
8732-123
WI
Other
Enumeration date
04/02/2019
Last updated
11/03/2022
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