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General NPI Number Information
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NPI Number | 1619232386
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Entity Type | Individual
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Provider Name | JORDAN LYMAN DYE LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1893 E SKYLINE DR STE 110D
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-5218
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Country | US
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Telephone | 801-901-3692
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Fax | 855-636-8306
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Provider Business Mailing Address
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Address Line | 320 CHERRY DR
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City | RIVERDALE
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State | UT
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Zip | 84405-5532
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Country | US
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Telephone | 801-901-3692
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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 | 117725763501
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License Number State | UT
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