Most Relevant Information
Provider Data
| NPI Number: | 1003255324 |
| Provider Name: | ANNALISE JOHN LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 25733 |
Most Important Dates
| Enumeration Date: | 06/19/2013 |
| Last Updated: | 08/21/2021 |
Provider Practice Location
3556 S 5600 W # 1-660
WEST VALLEY CITY
UT
841202815
Practice Location Phone/Fax
| Phone: | 6512695019 |
| Fax: |
Provider Mailing Location
3556 S 5600 W # 1-660
WEST VALLEY CITY
UT
841202815
Provider Mailing Phone/Fax
| Phone: | 6512695019 |
| Fax: |