Healthcare Provider Details

I. General information

NPI: 1326584392
Provider Name (Legal Business Name): CAMERON HAYNES CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W 800 S
ROOSEVELT UT
84066-3707
US

IV. Provider business mailing address

285 W 800 S
ROOSEVELT UT
84066-3707
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6300
  • Fax: 435-725-6325
Mailing address:
  • Phone: 435-725-6300
  • Fax: 435-725-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11087668-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: