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General NPI Number Information
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NPI Number | 1386938751
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Entity Type | Individual
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Provider Name | ALAN RUSHBY CHIDESTER LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 3135 N FAIRFIELD RD STE A
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City | LAYTON
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State | UT
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Zip | 84041-8832
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Country | US
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Telephone | 801-771-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 VINEYARD CIR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8800
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Country | US
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Telephone | 801-455-4089
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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 | 5935746-3501
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License Number State | UT
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