Healthcare Provider Details

I. General information

NPI: 1316866775
Provider Name (Legal Business Name): ALEXANDER QUINN SSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 S PARK AVE UNIT 520
RIVERTON UT
84065-3422
US

IV. Provider business mailing address

675 E 100 N APT 3
LOGAN UT
84321-4776
US

V. Phone/Fax

Practice location:
  • Phone: 208-404-2357
  • Fax:
Mailing address:
  • Phone: 208-404-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14284398-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: