Healthcare Provider Details

I. General information

NPI: 1912687435
Provider Name (Legal Business Name): KELLY REES-MAW CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

IV. Provider business mailing address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax: 801-782-8412
Mailing address:
  • Phone: 801-399-1818
  • Fax: 801-782-8412

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: