Healthcare Provider Details

I. General information

NPI: 1154890051
Provider Name (Legal Business Name): EMILY COOPER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 W 400 N
OREM UT
84057-4566
US

IV. Provider business mailing address

1451 N 1020 E
AMERICAN FORK UT
84003-3238
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10872697-3502
License Number StateUT

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: