Healthcare Provider Details

I. General information

NPI: 1679093660
Provider Name (Legal Business Name): MAIA ASHMORE SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 E 900 S
PROVO UT
84606-6107
US

IV. Provider business mailing address

750 N FREEDOM BLVD
PROVO UT
84601-1677
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-3779
  • Fax: 801-373-0639
Mailing address:
  • Phone: 801-852-1443
  • Fax: 801-373-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10396306-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: