Provider Demographics
NPI:1295305027
Name:VALLEJO, CAROL JANETTE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JANETTE
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N 2480 E
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5488
Mailing Address - Country:US
Mailing Address - Phone:435-229-7805
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE E102
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7305
Practice Address - Country:US
Practice Address - Phone:435-932-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12348416-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker