Healthcare Provider Details

I. General information

NPI: 1164299780
Provider Name (Legal Business Name): JOSHUA DUNFORD MSW-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14241 S REDWOOD RD STE 300
BLUFFDALE UT
84065-5223
US

IV. Provider business mailing address

3010 E 7180 S
COTTONWOOD HEIGHTS UT
84121-4346
US

V. Phone/Fax

Practice location:
  • Phone: 385-342-2808
  • Fax:
Mailing address:
  • Phone: 920-246-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: