Healthcare Provider Details

I. General information

NPI: 1376028084
Provider Name (Legal Business Name): SUSAN RENEE YOUNG CSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N 1680 E STE T2
ST GEORGE UT
84790-2573
US

IV. Provider business mailing address

8316 N 56TH LN
GLENDALE AZ
85302-6031
US

V. Phone/Fax

Practice location:
  • Phone: 435-429-3599
  • Fax:
Mailing address:
  • Phone: 435-592-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: