Healthcare Provider Details

I. General information

NPI: 1457287328
Provider Name (Legal Business Name): MARISSA DAWN OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADDRESS: 935 S OREM BLVD
OREM UT
84058
US

IV. Provider business mailing address

ADDRESS: 935 S OREM BLVD
OREM UT
84058
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-6772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14219422-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: