Healthcare Provider Details

I. General information

NPI: 1104637768
Provider Name (Legal Business Name): WILLOW THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S PLEASANT GROVE BLVD STE 201
PLEASANT GROVE UT
84062-2878
US

IV. Provider business mailing address

233 S PLEASANT GROVE BLVD STE 201
PLEASANT GROVE UT
84062-2878
US

V. Phone/Fax

Practice location:
  • Phone: 801-753-8193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY SCHNEIDER
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: MS SLP
Phone: 385-277-8685