Healthcare Provider Details

I. General information

NPI: 1619270295
Provider Name (Legal Business Name): MELINDA STOUT NEWSOME MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 W 3500 S
WEST VALLEY CITY UT
84119-2630
US

IV. Provider business mailing address

3392 W 3500 S
WEST VALLEY CITY UT
84119-2630
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-3307
  • Fax:
Mailing address:
  • Phone: 801-969-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number67156293502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: