Individual
LAURA PALMER FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
640 E 2300 N, NORTH OGDEN, UT 84414-2855
(801) 782-1068
Mailing address
640 E 2300 N, NORTH OGDEN, UT 84414-2855
(801) 782-1068
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
08/01/2010
Last updated
08/21/2019
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