Provider Demographics
NPI:1851901193
Name:COLEMERE, ANGELIQUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:
Last Name:COLEMERE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:COLEMERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:559 E EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2028
Mailing Address - Country:US
Mailing Address - Phone:385-800-1807
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 16
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2170
Practice Address - Country:US
Practice Address - Phone:385-800-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324450-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical