Healthcare Provider Details

I. General information

NPI: 1003573353
Provider Name (Legal Business Name): REBECCA JANE MCNAIRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 N UNIVERSITY AVE STE 250F
PROVO UT
84604-4481
US

IV. Provider business mailing address

1442 PEMBROKE CIR
OREM UT
84097-4404
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-5465
  • Fax:
Mailing address:
  • Phone: 801-310-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118012913501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: