Provider Demographics
NPI:1194436873
Name:LETERNEAU, CHRISTINA ASHLEY (CSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ASHLEY
Last Name:LETERNEAU
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ASHLEY
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:450 W 910 S STE 206
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2447
Mailing Address - Country:US
Mailing Address - Phone:435-777-3012
Mailing Address - Fax:
Practice Address - Street 1:450 W 910 S STE 206
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2447
Practice Address - Country:US
Practice Address - Phone:435-777-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13019765-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical