Individual
MARY P CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1190 N 900 E, PROVO, UT 84604-3536
(801) 422-7620
Mailing address
1190 N 900 E, LDS FAMILY SERVICES, PROVO, UT 84604-3536
(801) 422-7620
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
135563-3501
UT
Other
Enumeration date
04/23/2007
Last updated
11/18/2009
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