Provider Demographics
NPI:1558417311
Name:SIMEK, WENDY JAMES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JAMES
Last Name:SIMEK
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 1:3125 KENNEDY DR APT 306
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2170
Mailing Address - Country:US
Mailing Address - Phone:801-910-9351
Mailing Address - Fax:
Practice Address - Street 1:3125 KENNEDY DR
Practice Address - Street 2:#306
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2168
Practice Address - Country:US
Practice Address - Phone:801-910-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12923435011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1292343501OtherCLINICAL SOCIAL WORKER