Healthcare Provider Details

I. General information

NPI: 1326531286
Provider Name (Legal Business Name): MAYLIN WORLTON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 E TABERNACLE ST STE 7
ST GEORGE UT
84770-3187
US

IV. Provider business mailing address

4062 W SHADY PLUM WAY
SOUTH JORDAN UT
84009-3908
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-5131
  • Fax:
Mailing address:
  • Phone: 801-987-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12267027-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: