Individual
JAN WIMMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
186 E 1800 N, NORTH LOGAN, UT 84341-2019
(435) 770-1429
Mailing address
285 STONEHENGE DR, PROVIDENCE, UT 84332-9645
(435) 770-1429
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
125403-6008
UT
1041C0700X
Clinical Social Worker
Primary
125403-3501
UT
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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