Provider Demographics
NPI:1407135718
Name:THOMPSON, VICTORIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:STANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:618 S 1550 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8117
Mailing Address - Country:US
Mailing Address - Phone:801-628-6397
Mailing Address - Fax:
Practice Address - Street 1:780 S 2000 W STE A105
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9612
Practice Address - Country:US
Practice Address - Phone:801-628-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8357864-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1558439117Medicaid
UTU000091467Medicare PIN