Healthcare Provider Details

I. General information

NPI: 1164851416
Provider Name (Legal Business Name): VALERIE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9361 S 300 E
SANDY UT
84070-2902
US

IV. Provider business mailing address

PO BOX 204
MIDVALE UT
84047-0160
US

V. Phone/Fax

Practice location:
  • Phone: 801-826-5000
  • Fax:
Mailing address:
  • Phone: 424-274-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: