Individual
IESHA VICKTORIA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10382224-3502
UT
Other
Enumeration date
06/20/2017
Last updated
01/22/2025
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