Healthcare Provider Details

I. General information

NPI: 1598786139
Provider Name (Legal Business Name): STEVEN C VIGIL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 HARRISON BLVD
OGDEN UT
84403-4311
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-5620
  • Fax:
Mailing address:
  • Phone: 801-387-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2845313501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: