Healthcare Provider Details

I. General information

NPI: 1114550068
Provider Name (Legal Business Name): PATRICK DAWLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N CENTER ST
SALT LAKE CITY UT
84103-1625
US

IV. Provider business mailing address

314 N CENTER ST
SALT LAKE CITY UT
84103-1625
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-1707
  • Fax:
Mailing address:
  • Phone: 773-645-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14271474-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149024937
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: