Healthcare Provider Details

I. General information

NPI: 1720568942
Provider Name (Legal Business Name): ASHLEY TAYLOR WELLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12093 S BROKEN ARCH LN
HERRIMAN UT
84096-1201
US

IV. Provider business mailing address

12093 S BROKEN ARCH LN
HERRIMAN UT
84096-1201
US

V. Phone/Fax

Practice location:
  • Phone: 801-925-6289
  • Fax:
Mailing address:
  • Phone: 801-925-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98557883501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: