Individual
MIKENNA GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 587-3000
Mailing address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 587-3000
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11779968-3502
UT
Other
Enumeration date
10/28/2022
Last updated
10/28/2022
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