Provider Demographics
NPI:1861838567
Name:DALTON, LANA MARIE (MSW, CSW)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:MARIE
Last Name:DALTON
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E DOWNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2210
Mailing Address - Country:US
Mailing Address - Phone:801-699-6334
Mailing Address - Fax:
Practice Address - Street 1:411 N GRANT ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-2725
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:801-359-8510
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8559134-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical