Healthcare Provider Details

I. General information

NPI: 1134055387
Provider Name (Legal Business Name): ASHLYN JOY BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 S 1500 W STE 110
RIVERDALE UT
84405-7738
US

IV. Provider business mailing address

489 E 475 N
OGDEN UT
84404-3511
US

V. Phone/Fax

Practice location:
  • Phone: 385-330-2818
  • Fax:
Mailing address:
  • Phone: 801-358-8309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14221358-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: