Healthcare Provider Details

I. General information

NPI: 1689507774
Provider Name (Legal Business Name): TALIA LEE QUARTUCCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WASHINGTON BLVD STE 102D
OGDEN UT
84401-3623
US

IV. Provider business mailing address

2650 WASHINGTON BLVD STE 102D
OGDEN UT
84401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 801-391-1473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: