Doctor Name: | SHANNON LOUISE VANDERKOOI |
NPI Number: | 1023366127 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 54237883501 |
Business Practice Address: | 5698 W Glen Eagle Dr West Valley City, UT - 841284013 |
Business Phone Number: | 8019694181 |
Business Fax Number: | |
Mailing Address: | 6671 W Haven Maple Dr, WEST JORDAN |
State: | UT |
Postal Code: | 840812957 |
Phone Number: | 8013040943 |
Fax Number: | |
NPI Enumeration Date: | 08/21/2012 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 54237883501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |