Provider Demographics
NPI:1023792843
Name:LINGARD, AYAKA (CSW)
Entity type:Individual
Prefix:
First Name:AYAKA
Middle Name:
Last Name:LINGARD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W 850 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7510
Mailing Address - Country:US
Mailing Address - Phone:801-864-3832
Mailing Address - Fax:
Practice Address - Street 1:1133 N MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4830
Practice Address - Country:US
Practice Address - Phone:801-833-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12927031-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker