Individual
MCKENNA WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4215
Mailing address
1300 E CENTER ST, PROVO, UT 84606-3554
(801) 344-4215
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/12/2016
Last updated
09/16/2021
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