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General NPI Number Information
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NPI Number | 1154682672
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Entity Type | Individual
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Provider Name | HEATHER MOULTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 13222 TREE SPARROW DR STE R210
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City | RIVERTON
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State | UT
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Zip | 84096-2889
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Country | US
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Telephone | 801-872-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 11952 S 3085 W
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City | RIVERTON
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State | UT
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Zip | 84065-2413
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Country | US
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Telephone | 801-638-4910
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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 | 7177367-3501
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License Number State | UT
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