Healthcare Provider Details

I. General information

NPI: 1275839904
Provider Name (Legal Business Name): ALTHEDUS I TONEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 100 S STE 301
SALT LAKE CITY UT
84111-1727
US

IV. Provider business mailing address

344 E 100 S STE 301
SALT LAKE CITY UT
84111-1727
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-4257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7740536-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: