Healthcare Provider Details

I. General information

NPI: 1265362685
Provider Name (Legal Business Name): CYNTHIA WYATT CSW, LSUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

984 S 930 W
PAYSON UT
84651-3126
US

IV. Provider business mailing address

8376 S OLD BINGHAM HWY
WEST JORDAN UT
84088-5106
US

V. Phone/Fax

Practice location:
  • Phone: 385-438-4745
  • Fax:
Mailing address:
  • Phone: 385-438-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: