Healthcare Provider Details

I. General information

NPI: 1386182426
Provider Name (Legal Business Name): RICHARD NEWTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21260 N 1450 E
MORONI UT
84646
US

IV. Provider business mailing address

21260 N 1450 E
MORONI UT
84646-0461
US

V. Phone/Fax

Practice location:
  • Phone: 435-445-5200
  • Fax:
Mailing address:
  • Phone: 435-445-5200
  • Fax: 435-445-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1235458555
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: