Provider Demographics
NPI:1356687180
Name:HERNANDEZ, GUADALUPE LIZETH (CSW)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:LIZETH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S ADAMS ST APT 15
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3363
Mailing Address - Country:US
Mailing Address - Phone:801-931-7543
Mailing Address - Fax:
Practice Address - Street 1:345 E 4500 S STE 260
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3954
Practice Address - Country:US
Practice Address - Phone:801-747-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical