=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023440831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY STILLMAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2013
-----------------------------------------------------
Last Update Date | 03/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6836 S 1495 E
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-898-1908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6836 S 1495 E
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-898-1908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8356397-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 8356397-3503
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------