Healthcare Provider Details

I. General information

NPI: 1457081580
Provider Name (Legal Business Name): MARIANNE EVANS CLAYBURN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 S 11500 W
BRIDGELAND UT
84021
US

IV. Provider business mailing address

HC 64 BOX 452
BRIDGELAND UT
84021
US

V. Phone/Fax

Practice location:
  • Phone: 435-630-3151
  • Fax:
Mailing address:
  • Phone: 436-630-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13553421-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: