Healthcare Provider Details

I. General information

NPI: 1689518755
Provider Name (Legal Business Name): TIA KNOTTCLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8539 S REDWOOD RD
WEST JORDAN UT
84088-5250
US

IV. Provider business mailing address

1589 W WYNVIEW LN
SOUTH JORDAN UT
84095-8480
US

V. Phone/Fax

Practice location:
  • Phone: 801-919-4657
  • Fax: 801-919-4657
Mailing address:
  • Phone: 801-919-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: