Healthcare Provider Details

I. General information

NPI: 1093330466
Provider Name (Legal Business Name): MELISSA KELLER ADAMSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 E 1460 N
LOGAN UT
84341-2981
US

IV. Provider business mailing address

1698 E 1460 N
LOGAN UT
84341-2981
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-1230
  • Fax:
Mailing address:
  • Phone: 435-760-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9103276-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: