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Data Detail

Name: Cicely Claire Taravella 

Designation: Ph.D.

Issue Date: 7/27/2012

Expiration Date: 6/30/2024

License Number: 52 903

Disciplinary Action: None

Company: George E. Wahlen Dept. of VA Medical Center

City: Salt Lake City

State: UT

Zip: 84148

Work Phone: (801) 582-1565  Ext:2709

Civil Commitment Certification: