Provider Demographics
NPI:1073810362
Name:MARX, SANDRA JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:MARX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 S 800 W
Mailing Address - Street 2:SUITE J
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2080
Mailing Address - Country:US
Mailing Address - Phone:801-294-5224
Mailing Address - Fax:801-294-5269
Practice Address - Street 1:1492 S 800 W
Practice Address - Street 2:SUITE J
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-2080
Practice Address - Country:US
Practice Address - Phone:801-294-5224
Practice Address - Fax:801-294-5269
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111252-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical