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1538207154
KENNETH LAKE HENNEFER
MIDVALE, UT
NPI
1538207154
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: UT 116860-3501)
Enumeration Date
2007-02-03
Last Update Date
2007-07-08
Business Address
KENNETH LAKE HENNEFER LCSW
7321 S STATE ST STE A-B
MIDVALE, UT 84047-2055
Phone number: 801-352-2844
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Mailing Address
KENNETH LAKE HENNEFER LCSW
3231 MCNEILL CIR
SANDY, UT 84093-2136
Phone number: 801-942-1973
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