=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821636937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACI LYNN NEWLAND LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2019
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8420 S WASATCH BLVD
-----------------------------------------------------
City | COTTONWOOD HEIGHTS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-6043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-901-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2640 S ZIRCONIUM DR
-----------------------------------------------------
City | MAGNA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84044-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-834-3615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8624113-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------