Provider Demographics
NPI:1548376742
Name:MCKINNON, DAPHNE LYNN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:LYNN
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LEGEND DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7721
Mailing Address - Country:US
Mailing Address - Phone:916-512-5447
Mailing Address - Fax:
Practice Address - Street 1:1034 RSI DR UNIT 120
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-2203
Practice Address - Country:US
Practice Address - Phone:916-435-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207781041C0700X
UT11055197-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical