Healthcare Provider Details

I. General information

NPI: 1548194079
Provider Name (Legal Business Name): MALIA MCCRILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W BELLWOOD LN STE 1
SALT LAKE CITY UT
84123-4494
US

IV. Provider business mailing address

8063 CEDAR CT
SOUTH WEBER UT
84405-7719
US

V. Phone/Fax

Practice location:
  • Phone: 702-857-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14292365-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: