Provider Demographics
NPI:1285772947
Name:READ, ROGER (SOCIAL WORKER)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3194 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2526
Mailing Address - Country:US
Mailing Address - Phone:801-450-0999
Mailing Address - Fax:801-485-1651
Practice Address - Street 1:3194 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2526
Practice Address - Country:US
Practice Address - Phone:801-450-0999
Practice Address - Fax:801-485-1651
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114138-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical