Healthcare Provider Details

I. General information

NPI: 1477432912
Provider Name (Legal Business Name): ZACHARIAH LEE CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 S MAIN ST
TOOELE UT
84074-2747
US

IV. Provider business mailing address

1959 N AARON DR STE C
TOOELE UT
84074-8111
US

V. Phone/Fax

Practice location:
  • Phone: 435-274-3067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14128806-3502
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: