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Individual

MARISSA SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CSW

Contact information

Practice address
873 BAXTER DR, SOUTH JORDAN, UT 84095-8506
(801) 657-0163
Mailing address
PO BOX 708458, SANDY, UT 84070-8458

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7736405-3502
UT

Other

Enumeration date
07/06/2011
Last updated
07/06/2011
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