Provider Demographics
NPI:1144597303
Name:EVANOFF, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:EVANOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 E SOUTH TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1413
Mailing Address - Country:US
Mailing Address - Phone:801-533-0070
Mailing Address - Fax:801-596-2240
Practice Address - Street 1:974 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1413
Practice Address - Country:US
Practice Address - Phone:801-533-0070
Practice Address - Fax:801-596-2240
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker