Healthcare Provider Details

I. General information

NPI: 1033923339
Provider Name (Legal Business Name): ISABELLA MAUTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BELLA MAUTONE

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 W BAXTER DR
SOUTH JORDAN UT
84095-8506
US

IV. Provider business mailing address

873 W BAXTER DR
SOUTH JORDAN UT
84095-8506
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-3515
  • Fax:
Mailing address:
  • Phone: 801-446-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: