Healthcare Provider Details

I. General information

NPI: 1407531858
Provider Name (Legal Business Name): JULIETTE CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD STE C118
MIDVALE UT
84047-5512
US

IV. Provider business mailing address

455 S 700 E UNIT 2502
SALT LAKE CITY UT
84102-3879
US

V. Phone/Fax

Practice location:
  • Phone: 801-792-4867
  • Fax:
Mailing address:
  • Phone: 818-309-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: