Healthcare Provider Details

I. General information

NPI: 1972060200
Provider Name (Legal Business Name): IRYNA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 W 4100 S
WEST VALLEY CITY UT
84120-5411
US

IV. Provider business mailing address

3725 W 4100 S STE 201
WEST VALLEY CITY UT
84120-5427
US

V. Phone/Fax

Practice location:
  • Phone: 888-949-4864
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14223810-3503
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF24-113767
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: