Healthcare Provider Details

I. General information

NPI: 1184114662
Provider Name (Legal Business Name): EMILY BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 HARRISON BLVD STE 300
OGDEN UT
84403-2362
US

IV. Provider business mailing address

3903 HARRISON BLVD STE 300
OGDEN UT
84403-2362
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-5600
  • Fax:
Mailing address:
  • Phone: 801-387-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8661508-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: