Provider Demographics
NPI:1851761589
Name:PERKINS, VANESSA C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:C
Last Name:PERKINS
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 1:4590 S PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4785
Mailing Address - Country:US
Mailing Address - Phone:435-260-4959
Mailing Address - Fax:
Practice Address - Street 1:4505 S WASATCH BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4755
Practice Address - Country:US
Practice Address - Phone:435-260-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7395044-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical