Provider Demographics
NPI:1013239466
Name:STODDARD, CARLA JOAN (MSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JOAN
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 1500 W
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5216
Mailing Address - Country:US
Mailing Address - Phone:801-313-7836
Mailing Address - Fax:801-313-7805
Practice Address - Street 1:1945 S 1100 E
Practice Address - Street 2:SUITE 206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2369
Practice Address - Country:US
Practice Address - Phone:801-891-8119
Practice Address - Fax:801-313-7805
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT326286-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical