Provider Demographics
NPI:1588632822
Name:BANK, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:BANK
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 1:1400 FOOTHILL DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2327
Mailing Address - Country:US
Mailing Address - Phone:801-581-0422
Mailing Address - Fax:801-581-0764
Practice Address - Street 1:1400 FOOTHILL DR
Practice Address - Street 2:SUITE 24
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2327
Practice Address - Country:US
Practice Address - Phone:801-581-0422
Practice Address - Fax:801-581-0764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4924826-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical