Healthcare Provider Details

I. General information

NPI: 1215156286
Provider Name (Legal Business Name): CONNIE POWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S 2200 W
SYRACUSE UT
84075-7187
US

IV. Provider business mailing address

1412 S LEGEND HILLS DR
CLEARFIELD UT
84015-1587
US

V. Phone/Fax

Practice location:
  • Phone: 385-558-8466
  • Fax:
Mailing address:
  • Phone: 385-558-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number345500-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: