Healthcare Provider Details

I. General information

NPI: 1902725138
Provider Name (Legal Business Name): MALLORY JILL MCCARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S RIO GRANDE ST
SALT LAKE CITY UT
84101-1136
US

IV. Provider business mailing address

640 E NORMANDY LOOP LN
DRAPER UT
84020-9687
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-8051
  • Fax:
Mailing address:
  • Phone: 385-208-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: