Healthcare Provider Details

I. General information

NPI: 1326235813
Provider Name (Legal Business Name): A. PAIGE PALMER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E 4800 S STE 250
MURRAY UT
84107-5519
US

IV. Provider business mailing address

825 E 4800 S STE 250
MURRAY UT
84107-5519
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-2305
  • Fax:
Mailing address:
  • Phone: 801-262-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86 131 972 3501
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: A. PAIGE PAIGE PALMER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 801-572-4613