Provider Demographics
NPI:1730783960
Name:FEHOKO, LAKIESHA SHAWAN
Entity type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:SHAWAN
Last Name:FEHOKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKIESHA
Other - Middle Name:SHAWAN
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:547 W 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7100
Mailing Address - Country:US
Mailing Address - Phone:801-265-8000
Mailing Address - Fax:801-265-8004
Practice Address - Street 1:547 W 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-7100
Practice Address - Country:US
Practice Address - Phone:801-265-8000
Practice Address - Fax:801-265-8004
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8663200-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical