Individual
MARILEE VANWAGENEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
151 S UNIVERSITY AVE STE 3200, PROVO, UT 84601-4427
(801) 851-7128
Mailing address
151 S UNIVERSITY AVE STE 3200, PROVO, UT 84601-4427
(801) 851-7128
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
140473-3501
UT
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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