Provider Demographics
NPI:1760545651
Name:CANNON, KAREN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CANNON
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 1:5250 S COMMERCE DR
Mailing Address - Street 2:STE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-261-3500
Mailing Address - Fax:801-261-2111
Practice Address - Street 1:5250 S COMMERCE DR
Practice Address - Street 2:STE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:801-261-2111
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13108535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical