Healthcare Provider Details

I. General information

NPI: 1003740218
Provider Name (Legal Business Name): ELLEN HARMSTON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLIE HARMSTON CSW

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

IV. Provider business mailing address

409 W 400 S
SALT LAKE CITY UT
84101-1135
US

V. Phone/Fax

Practice location:
  • Phone: 385-466-1570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14289399-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: