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General NPI Number Information
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NPI Number | 1437675071
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Entity Type | Individual
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Provider Name | MARISSA MILLER
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 06/04/2023
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Provider Practice Location Address
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Address Line | 448 E WINCHESTER ST STE 110
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City | MURRAY
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State | UT
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Zip | 84107-8538
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Country | US
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Telephone | 801-694-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E ST # 2
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City | SLC
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State | UT
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Zip | 84103-2832
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Country | US
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Telephone |
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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 | 9498512-3502
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License Number State | UT
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