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Individual

MS. ROBERTA POLKINGHORN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, CMHC, LPC, CPC,

Contact information

Practice address
1553 E OWENWOOD CIR, SANDY, UT 84092-5381
(801) 518-3554
Mailing address
1553 E OWENWOOD CIR, SANDY, UT 84092-5381
(801) 518-3554

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10728504-6004
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0701011742
LPC
VA
01
10728504-6004
CMHC
UT
01
267724
NCC
01
CP5288-R
CPC
NV
Enumeration date
09/07/2014
Last updated
12/02/2022
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