Healthcare Provider Details

I. General information

NPI: 1083024624
Provider Name (Legal Business Name): RUSTIE CHASTINA WAYNE-JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E 300 S
SALT LAKE CITY UT
84102-2256
US

IV. Provider business mailing address

117 W 400 S
SALT LAKE CITY UT
84101-1916
US

V. Phone/Fax

Practice location:
  • Phone: 801-428-3490
  • Fax:
Mailing address:
  • Phone: 385-200-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113215515-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: