Provider Demographics
NPI:1609663400
Name:DOS SANTOS WANAMAKER, NADJA (LCSW)
Entity type:Individual
Prefix:
First Name:NADJA
Middle Name:
Last Name:DOS SANTOS WANAMAKER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3016
Mailing Address - Country:US
Mailing Address - Phone:385-414-7484
Mailing Address - Fax:
Practice Address - Street 1:476 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3016
Practice Address - Country:US
Practice Address - Phone:385-414-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13408418-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical