Healthcare Provider Details

I. General information

NPI: 1427104702
Provider Name (Legal Business Name): MICHELLE ANN PAXTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E SHELLY LOUISE DR
SANDY UT
84070-4253
US

IV. Provider business mailing address

PO BOX 3264
SALT LAKE CITY UT
84110-3264
US

V. Phone/Fax

Practice location:
  • Phone: 801-685-2110
  • Fax: 801-685-9570
Mailing address:
  • Phone: 801-685-2110
  • Fax: 801-685-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-2399
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number309176-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: