Healthcare Provider Details

I. General information

NPI: 1306778857
Provider Name (Legal Business Name): COLLEEN LOUISE GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N 1330 W STE A1
OREM UT
84057-5116
US

IV. Provider business mailing address

1070 E 135 S
LINDON UT
84042-2103
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-3040
  • Fax:
Mailing address:
  • Phone: 801-960-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: