Healthcare Provider Details

I. General information

NPI: 1952850232
Provider Name (Legal Business Name): CARALEE CHILD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403
US

IV. Provider business mailing address

2792 N 4975 E
EDEN UT
84310-9800
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-4965
  • Fax:
Mailing address:
  • Phone: 801-589-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9822413-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: