Healthcare Provider Details

I. General information

NPI: 1033891122
Provider Name (Legal Business Name): MCKAYLA M ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W 300 N STE 1
HYDE PARK UT
84318-4044
US

IV. Provider business mailing address

338 W 300 N STE 1
HYDE PARK UT
84318-4044
US

V. Phone/Fax

Practice location:
  • Phone: 435-774-4113
  • Fax:
Mailing address:
  • Phone: 435-774-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13989906-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: