Provider Demographics
NPI:1326783556
Name:VICKREY, MEGHAN P (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:P
Last Name:VICKREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 W DEER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6019
Mailing Address - Country:US
Mailing Address - Phone:801-432-0778
Mailing Address - Fax:
Practice Address - Street 1:3973 W DEER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6019
Practice Address - Country:US
Practice Address - Phone:801-432-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7050579-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty