Provider Demographics
NPI:1770121717
Name:VIGIL, DANIELLE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:VIGIL
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 1:6975 S UNION PARK CTR STE 600
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4187
Mailing Address - Country:US
Mailing Address - Phone:385-341-1934
Mailing Address - Fax:
Practice Address - Street 1:6975 S UNION PARK CTR STE 617
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6048
Practice Address - Country:US
Practice Address - Phone:385-341-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7080077-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1770121717Medicaid