Healthcare Provider Details

I. General information

NPI: 1770121717
Provider Name (Legal Business Name): DANIELLE MARIE VIGIL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 S HIGHLAND DR STE 240
MILLCREEK UT
84117-4243
US

IV. Provider business mailing address

4578 S HIGHLAND DR STE 240
MILLCREEK UT
84117-4243
US

V. Phone/Fax

Practice location:
  • Phone: 801-557-3659
  • Fax:
Mailing address:
  • Phone: 801-557-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7080077-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: