Healthcare Provider Details

I. General information

NPI: 1689320590
Provider Name (Legal Business Name): BETHANY CZUBA CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 W 3000 S
OGDEN UT
84401-9702
US

IV. Provider business mailing address

4842 W 3000 S
OGDEN UT
84401-9702
US

V. Phone/Fax

Practice location:
  • Phone: 385-832-6022
  • Fax:
Mailing address:
  • Phone: 385-389-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11932083-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: