Individual
ANNALISA BLACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3392 W 3500 S, WEST VALLEY CITY, UT 84119-2630
(801) 969-3307
Mailing address
3392 W 3500 S, WEST VALLEY CITY, UT 84119-2630
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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