Healthcare Provider Details

I. General information

NPI: 1184540650
Provider Name (Legal Business Name): CONSTANCE MCDONALD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE MCDONALD LCSW

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 W 2980 S
NIBLEY UT
84321-6470
US

IV. Provider business mailing address

829 W 2980 S
NIBLEY UT
84321-6470
US

V. Phone/Fax

Practice location:
  • Phone: 435-248-2462
  • Fax:
Mailing address:
  • Phone: 435-248-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13989890-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: