Healthcare Provider Details

I. General information

NPI: 1588239248
Provider Name (Legal Business Name): ELIZABETH ANN GAUL CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 S 1700 E
SALT LAKE CITY UT
84106-4123
US

IV. Provider business mailing address

3330 S 2700 E APT 4
MILLCREEK UT
84109-3088
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9376
  • Fax:
Mailing address:
  • Phone: 801-428-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14046213-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: