Healthcare Provider Details

I. General information

NPI: 1437067345
Provider Name (Legal Business Name): MICHELLE MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 S HIGHLAND DR STE 200
HOLLADAY UT
84121-6561
US

IV. Provider business mailing address

6168 W BIRCH RUN RD
SOUTH JORDAN UT
84009-1275
US

V. Phone/Fax

Practice location:
  • Phone: 801-472-0606
  • Fax:
Mailing address:
  • Phone: 801-472-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13151258-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: