Individual
MARY J. WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
189 S STATE ST STE 245, CLEARFIELD, UT 84015-1001
(385) 240-1442
Mailing address
189 S STATE ST STE 245, CLEARFIELD, UT 84015-1001
(385) 240-1442
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7754639-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
09/14/2009
Last updated
05/08/2023
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