Individual
KENNETH LAKE HENNEFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7321 S STATE ST, STE A-B, MIDVALE, UT 84047-2055
(801) 352-2844
(801) 942-1973
Mailing address
3231 MCNEILL CIR, SANDY, UT 84093-2136
(801) 942-1973
(801) 942-1973
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
116860-3501
UT
Other
Enumeration date
02/03/2007
Last updated
07/08/2007
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