Healthcare Provider Details

I. General information

NPI: 1679312045
Provider Name (Legal Business Name): MIRANDA WEST CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 W CENTER ST
OREM UT
84057-4659
US

IV. Provider business mailing address

3651 N 100 E STE 375
PROVO UT
84604-4511
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-3131
  • Fax: 800-785-2607
Mailing address:
  • Phone: 801-645-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13986691-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: