Healthcare Provider Details

I. General information

NPI: 1407268758
Provider Name (Legal Business Name): MARIANNE DAVIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 HARRISON BLVD STE 100
OGDEN UT
84403-1271
US

IV. Provider business mailing address

3340 HARRISON BLVD STE 100
OGDEN UT
84403-1271
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-3113
  • Fax: 801-394-1910
Mailing address:
  • Phone: 801-393-3113
  • Fax: 801-394-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: