Healthcare Provider Details

I. General information

NPI: 1982977211
Provider Name (Legal Business Name): RYAN SCOTT PEPPER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 HORIZON POINT CIR
DRAPER UT
84020-8880
US

IV. Provider business mailing address

1754 HORIZON POINT CIR
DRAPER UT
84020-8880
US

V. Phone/Fax

Practice location:
  • Phone: 801-910-5894
  • Fax: 801-838-8920
Mailing address:
  • Phone: 801-910-5894
  • Fax: 801-838-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5335936-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: