Healthcare Provider Details

I. General information

NPI: 1629995808
Provider Name (Legal Business Name): RAYVIN RHODES CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 100 S
SALT LAKE CITY UT
84102-4210
US

IV. Provider business mailing address

525 E 100 S
SALT LAKE CITY UT
84102-4210
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1212
  • Fax: 801-585-9096
Mailing address:
  • Phone: 801-585-1212
  • Fax: 801-585-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number142852083502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: