Individual
MANDY DONAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
258 S MAIN ST, LOGAN, UT 84321-5767
(435) 512-9492
Mailing address
1248 GRANDVIEW DR, PROVIDENCE, UT 84332-9317
(435) 512-9492
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
69837453501
UT
Other
Enumeration date
04/14/2018
Last updated
04/14/2018
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