Healthcare Provider Details

I. General information

NPI: 1598191892
Provider Name (Legal Business Name): MARIA CECILIA J STAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 LINCOLN AVE STE 102
OGDEN UT
84401-6516
US

IV. Provider business mailing address

2036 LINCOLN AVE STE 102
OGDEN UT
84401-6516
US

V. Phone/Fax

Practice location:
  • Phone: 801-719-7737
  • Fax: 888-887-9784
Mailing address:
  • Phone: 801-719-7737
  • Fax: 888-887-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: