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1457871592
IESHA VICKTORIA LOPEZ
PROVO, UT
NPI
1457871592
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Former Name
IESHA VICKTORIA BAILEY
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: UT 10382224-3502)
Enumeration Date
2017-06-20
Last Update Date
2025-01-22
Business Address
IESHA VICKTORIA LOPEZ LCSW
750 N FREEDOM BLVD
PROVO, UT 84601
Phone number: 801-373-4760
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Mailing Address
IESHA VICKTORIA LOPEZ LCSW
750 N FREEDOM BLVD
PROVO, UT 84601-1677
Phone number: 801-373-4760
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