Provider Demographics
NPI:1467083592
Name:MARKEWITZ, VERONIQUE
Entity Type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:
Last Name:MARKEWITZ
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:PO BOX 58515
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-0515
Mailing Address - Country:US
Mailing Address - Phone:435-200-4767
Mailing Address - Fax:
Practice Address - Street 1:4055 S 700 E STE 102F
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2174
Practice Address - Country:US
Practice Address - Phone:435-200-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11587632-3506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker