Healthcare Provider Details

I. General information

NPI: 1669381026
Provider Name (Legal Business Name): LIBERTY MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 W MARKET CENTER DR # 1200
BLUFFDALE UT
84065-8026
US

IV. Provider business mailing address

3740 W MARKET CENTER DR # 1200
BLUFFDALE UT
84065-8026
US

V. Phone/Fax

Practice location:
  • Phone: 801-240-9436
  • Fax:
Mailing address:
  • Phone: 801-240-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: