Healthcare Provider Details

I. General information

NPI: 1922760222
Provider Name (Legal Business Name): DALLYN SCOTT STEENERSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 S 1200 E APT 501
SALT LAKE CITY UT
84105-3527
US

IV. Provider business mailing address

1963 S 1200 E APT 501
SALT LAKE CITY UT
84105-3527
US

V. Phone/Fax

Practice location:
  • Phone: 910-795-7604
  • Fax:
Mailing address:
  • Phone: 910-795-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124072073502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11391-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: