Healthcare Provider Details

I. General information

NPI: 1861303133
Provider Name (Legal Business Name): CHARLOTTE L SELLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 W 12600 S STE 2B
RIVERTON UT
84065-7173
US

IV. Provider business mailing address

9325 S GRAND TETON DR
WEST JORDAN UT
84088-6380
US

V. Phone/Fax

Practice location:
  • Phone: 801-317-8522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14286049-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: