Doctor Name: | PAMELA JOAN BENNETT |
NPI Number: | 1215196647 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 54668946501 |
Business Practice Address: | 100 S 1000 W Tooele, UT - 840744010 |
Business Phone Number: | 4358433520 |
Business Fax Number: | |
Mailing Address: | 5965 S 900 E, SALT LAKE CITY |
State: | UT |
Postal Code: | 841211720 |
Phone Number: | 8012637100 |
Fax Number: | |
NPI Enumeration Date: | 06/02/2008 |
NPI Last Update Date: | 07/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 54668946501 |
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 |