Healthcare Provider Details

I. General information

NPI: 1578922027
Provider Name (Legal Business Name): MARTINA E BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT # 4758
WEST JORDAN UT
84084-5526
US

IV. Provider business mailing address

7533 S CENTER VIEW CT # 4758
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 801-718-9647
  • Fax: 801-373-0639
Mailing address:
  • Phone: 801-718-9647
  • Fax: 801-373-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11197721-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: