Healthcare Provider Details

I. General information

NPI: 1679118160
Provider Name (Legal Business Name): STEPHAN BADGETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13431 S PARK PRESIDIO WAY UNIT 1906
DRAPER UT
84020-1999
US

IV. Provider business mailing address

13431 S PARK PRESIDIO WAY UNIT 1906
DRAPER UT
84020-1999
US

V. Phone/Fax

Practice location:
  • Phone: 626-602-4818
  • Fax:
Mailing address:
  • Phone: 626-602-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13532932-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: