Provider Demographics
NPI:1265529267
Name:BACH WHITEHEAD, TRUDY (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:
Last Name:BACH WHITEHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 E 4800 SO
Mailing Address - Street 2:#200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-685-9500
Mailing Address - Fax:801-265-9604
Practice Address - Street 1:845 E 4800 SO
Practice Address - Street 2:#200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-685-9500
Practice Address - Fax:801-265-9604
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1209683501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker