Healthcare Provider Details

I. General information

NPI: 1275483976
Provider Name (Legal Business Name): SUSAN ELAINE SMAELLIE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E 7800 S
MIDVALE UT
84047-2653
US

IV. Provider business mailing address

1914 E RIO CIR
SANDY UT
84093-6924
US

V. Phone/Fax

Practice location:
  • Phone: 801-826-8800
  • Fax:
Mailing address:
  • Phone: 801-943-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14239971-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: