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NPI Code Detail

MEDICARE: EVELYN AISSA ACOSTA

MEDICARE: EVELYN AISSA ACOSTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225C00000XRehabilitation Counselor
21041C0700XClinical Social Worker14225228-3502UT

General Provider Information

NPI Number : 1821771916
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN AISSA ACOSTA
Provider Business Mailing Address
First Line : 154 W 600 S UNIT 538
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84101-2835
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7625 S 3200 W STE 2
Second Line :
City : WEST JORDAN
State : UT
Zip : 84084-2887
Country : US
Telephone Number : 801-915-0359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2023
Last Update Date : 06/11/2026

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Directions to “ EVELYN AISSA ACOSTA ” Practice Location

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