Healthcare Provider Details

I. General information

NPI: 1225578875
Provider Name (Legal Business Name): GARRETT CORY PLANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date: 10/23/2019
Reactivation Date: 02/06/2020

III. Provider practice location address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

IV. Provider business mailing address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-3330
  • Fax: 801-459-1200
Mailing address:
  • Phone: 307-349-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: