Individual
LORI MARIE WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 343-4760
Mailing address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
14220747-3502
UT
1041C0700X
Clinical Social Worker
Primary
14220747-3502
UT
106S00000X
Behavior Technician
—
—
Other
Enumeration date
11/04/2022
Last updated
05/15/2026
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