Healthcare Provider Details

I. General information

NPI: 1629388202
Provider Name (Legal Business Name): THERESA ROSE OCONNOR P.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E EXECUTIVE PARK DR STE B
MURRAY UT
84117-3545
US

IV. Provider business mailing address

5446 W KATHLEEN AVE
WEST VALLEY CITY UT
84120-2712
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-0857
  • Fax: 801-880-2859
Mailing address:
  • Phone: 801-859-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6681105
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5932
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8634614-6004
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8634614-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: