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General NPI Number Information
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NPI Number | 1265016257
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Entity Type | Individual
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Provider Name | MATTISON DOMAN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 10428 S 4000 W
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-5794
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Country | US
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Telephone | 801-556-8839
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Fax |
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Provider Business Mailing Address
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Address Line | 12297 S PEDROIA ST
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City | HERRIMAN
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State | UT
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Zip | 84096-2979
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Country | US
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Telephone | 801-556-8839
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | UT
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