Healthcare Provider Details

I. General information

NPI: 1699301754
Provider Name (Legal Business Name): JULIE KRISTINE CHACON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 02/07/2024
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 INDUSTRIAL PARK RD STE 20
OREM UT
84057-2803
US

IV. Provider business mailing address

931 INDUSTRIAL PARK RD STE 20
OREM UT
84057-2803
US

V. Phone/Fax

Practice location:
  • Phone: 385-269-0727
  • Fax:
Mailing address:
  • Phone: 385-269-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8046438-3501
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: