Healthcare Provider Details

I. General information

NPI: 1891605374
Provider Name (Legal Business Name): ABBIE RANAE THURGOOD CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E 900 S STE 209
SALT LAKE CITY UT
84111-4251
US

IV. Provider business mailing address

177 E 900 S STE 209
SALT LAKE CITY UT
84111-4251
US

V. Phone/Fax

Practice location:
  • Phone: 801-647-1143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14304479-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: