Healthcare Provider Details

I. General information

NPI: 1851203350
Provider Name (Legal Business Name): TALIA REZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4695 S 1900 W STE 6
ROY UT
84067-2669
US

IV. Provider business mailing address

2993 GOLDEN SPIKE CT
PLEASANT VIEW UT
84404-1366
US

V. Phone/Fax

Practice location:
  • Phone: 801-931-0488
  • Fax:
Mailing address:
  • Phone: 801-430-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number143081073502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: