Healthcare Provider Details

I. General information

NPI: 1578491080
Provider Name (Legal Business Name): PAULA K FISH CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S HIGHWAY 89 APT 111
NORTH SALT LAKE UT
84054-2452
US

IV. Provider business mailing address

200 S HIGHWAY 89 APT 111
NORTH SALT LAKE UT
84054-2452
US

V. Phone/Fax

Practice location:
  • Phone: 928-243-4462
  • Fax:
Mailing address:
  • Phone: 928-243-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14267880-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: