Individual
MARY LOU WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1790 N STATE ST, OREM, UT 84057-2025
(801) 224-8255
(801) 224-8301
Mailing address
1790 N STATE ST, OREM, UT 84057-2025
(801) 224-8255
(801) 224-8301
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
134492-3501
UT
Other
Enumeration date
04/03/2009
Last updated
04/03/2009
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