Healthcare Provider Details

I. General information

NPI: 1245170679
Provider Name (Legal Business Name): TAMMY M WHITE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 S 900 E
MURRAY UT
84121-1644
US

IV. Provider business mailing address

5814 S 900 E
MURRAY UT
84121-1644
US

V. Phone/Fax

Practice location:
  • Phone: 435-625-1011
  • Fax:
Mailing address:
  • Phone: 435-625-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13487747-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: