Provider Demographics
NPI:1952640831
Name:WARD, WANDA L (LMSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:L
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4460 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3543
Mailing Address - Country:US
Mailing Address - Phone:888-949-4864
Mailing Address - Fax:208-375-0796
Practice Address - Street 1:4460 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:888-949-4864
Practice Address - Fax:208-375-0796
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health