Healthcare Provider Details

I. General information

NPI: 1134793847
Provider Name (Legal Business Name): MELISSA NICOLE YLST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W CENTER ST
OREM UT
84057-5207
US

IV. Provider business mailing address

841 E ROCKY MOUTH LN
DRAPER UT
84020-7604
US

V. Phone/Fax

Practice location:
  • Phone: 801-903-5903
  • Fax:
Mailing address:
  • Phone: 801-699-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: