Healthcare Provider Details

I. General information

NPI: 1104534015
Provider Name (Legal Business Name): MICHELLE JEAN SINGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 100 S
SALT LAKE CITY UT
84111-1700
US

IV. Provider business mailing address

344 E 100 S
SALT LAKE CITY UT
84111-1700
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF25-119264
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberF23-102910
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: