Provider Demographics
NPI:1285790642
Name:WILCOX, CATHY LYNN (SSW)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:LYNN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SSW
Mailing Address - Street 1:894 FRANCIS CIR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9661
Mailing Address - Country:US
Mailing Address - Phone:801-546-8274
Mailing Address - Fax:801-546-3019
Practice Address - Street 1:2250 ROBINS DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-773-7060
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1366653503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker