Healthcare Provider Details

I. General information

NPI: 1982243390
Provider Name (Legal Business Name): MICHAEL WRIGHT CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5383 S 900 E STE 103
MURRAY UT
84117-7266
US

IV. Provider business mailing address

31 WRIGHT LN
JAMESTOWN RI
02835-1714
US

V. Phone/Fax

Practice location:
  • Phone: 801-872-5516
  • Fax:
Mailing address:
  • Phone: 401-835-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115097343502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: