Healthcare Provider Details

I. General information

NPI: 1770177586
Provider Name (Legal Business Name): MELISSA MARIE WESTFALL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3586 W 850 S
SYRACUSE UT
84075-9802
US

IV. Provider business mailing address

5398 KAHLER DR NE
ALBERTVILLE MN
55301-9764
US

V. Phone/Fax

Practice location:
  • Phone: 330-430-9250
  • Fax:
Mailing address:
  • Phone: 330-430-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14284768-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0011975
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32582
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: