Healthcare Provider Details

I. General information

NPI: 1154870244
Provider Name (Legal Business Name): MS. LAUREL ROMNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD
MIDVALE UT
84047-1531
US

IV. Provider business mailing address

325 W 700 N APT 6
SALT LAKE CITY UT
84103-1386
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-8870
  • Fax:
Mailing address:
  • Phone: 801-785-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10374812-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: