Provider Demographics
NPI:1982209946
Name:LILJA, ELISABETH THOMAS (MSW,LCSW,RYT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:THOMAS
Last Name:LILJA
Suffix:
Gender:F
Credentials:MSW,LCSW,RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 E PALISADE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2315
Mailing Address - Country:US
Mailing Address - Phone:801-842-6234
Mailing Address - Fax:
Practice Address - Street 1:3570 E PALISADE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2315
Practice Address - Country:US
Practice Address - Phone:801-842-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10854740-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical