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General NPI Number Information
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NPI Number | 1972177525
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Entity Type | Individual
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Provider Name | SKYLER PORTER CSW
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Gender | Male
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 275 W 100 S
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City | DELTA
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State | UT
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Zip | 84624-9238
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Country | US
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Telephone | 435-922-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 21 NORTH HIGHWAY 6
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City | LYNNDYL
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State | UT
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Zip | 84640
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Country | US
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Telephone | 435-406-6370
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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 | 11805199-3502
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License Number State | UT
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