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General NPI Number Information
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NPI Number | 1528375607
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Entity Type | Individual
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Provider Name | JUSTYN HASKELL MANLEY JUSTYN MANLEY
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Gender | Female
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 1912 SIDEWINDER DR STE 201
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City | PARK CITY
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State | UT
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Zip | 84060-7257
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Country | US
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Telephone | 435-640-1327
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Fax |
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Provider Business Mailing Address
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Address Line | 8947 N PROMONTORY RIDGE DR
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City | PARK CITY
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State | UT
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Zip | 84098-5786
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Country | US
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Telephone | 435-640-1327
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8262078-3502
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8262078-3501
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License Number State | UT
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