Provider Demographics
NPI:1386082477
Name:VAN ORMAN, AUBREY T (CSW)
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:T
Last Name:VAN ORMAN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 EAST 100 NORTH
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642
Mailing Address - Country:US
Mailing Address - Phone:435-851-9613
Mailing Address - Fax:
Practice Address - Street 1:490 E 100 N
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642-1116
Practice Address - Country:US
Practice Address - Phone:435-851-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8601498-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1235458555Medicaid