Individual
KERRY FANNIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
4734 W 12400 S, PAYSON, UT 84651-9637
(661) 317-6067
Mailing address
1739 SOUTH 2900 EAST, SPANISH FORK, UT 84660
(661) 317-6067
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7125639-3502
UT
Other
Enumeration date
02/10/2015
Last updated
02/10/2015
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