Healthcare Provider Details

I. General information

NPI: 1013454891
Provider Name (Legal Business Name): MORGAN KELLEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S MAIN ST
LAYTON UT
84041-7135
US

IV. Provider business mailing address

3839 S WEST TEMPLE APT B112
SOUTH SALT LAKE UT
84115-5650
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-7060
  • Fax:
Mailing address:
  • Phone: 801-755-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13470786-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: