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General NPI Number Information
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NPI Number | 1013449198
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Entity Type | Individual
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Provider Name | CARISSA RETTIG CSW
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 1186 E 4600 S STE 200
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City | OGDEN
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State | UT
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Zip | 84403-5097
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Country | US
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Telephone | 801-675-8856
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Fax |
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Provider Business Mailing Address
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Address Line | 195 N 1950 W
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-3100
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Country | US
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Telephone | 801-538-4001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14065791-3502
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License Number State | UT
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