Provider Demographics
NPI:1033533377
Name:BANGERTER FOY, JO LONNA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JO LONNA
Middle Name:LYNN
Last Name:BANGERTER FOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BOX ELDER WAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84312-9789
Mailing Address - Country:US
Mailing Address - Phone:801-792-6974
Mailing Address - Fax:
Practice Address - Street 1:60 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-6794
Practice Address - Country:US
Practice Address - Phone:435-224-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7459428-3502104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker