Healthcare Provider Details

I. General information

NPI: 1225707169
Provider Name (Legal Business Name): STEPHANIE PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 W MAIN ST
LEHI UT
84043-2050
US

IV. Provider business mailing address

252 W MAIN ST
LEHI UT
84043-2050
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-3676
  • Fax: 801-901-6364
Mailing address:
  • Phone: 801-980-3676
  • Fax: 801-901-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: