Healthcare Provider Details

I. General information

NPI: 1417623018
Provider Name (Legal Business Name): JASON TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 W MAPLE LOOP DR STE 300
LEHI UT
84048-6552
US

IV. Provider business mailing address

3051 W MAPLE LOOP DR STE 300
LEHI UT
84048-6552
US

V. Phone/Fax

Practice location:
  • Phone: 801-405-7450
  • Fax: 385-446-2650
Mailing address:
  • Phone: 801-405-7450
  • Fax: 385-446-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7839079-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: