Healthcare Provider Details

I. General information

NPI: 1689551954
Provider Name (Legal Business Name): EMMA THOMPSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 N 1200 W
OREM UT
84057-2445
US

IV. Provider business mailing address

659 N 700 E APT 18
PROVO UT
84606-6907
US

V. Phone/Fax

Practice location:
  • Phone: 801-229-1181
  • Fax:
Mailing address:
  • Phone: 702-238-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14287246-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: