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NPI Code Detail

MEDICARE: STACI LYN REITZ

MEDICARE: STACI LYN REITZ
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
11041C0700XClinical Social Worker14290295-3502UT

General Provider Information

NPI Number : 1861287732
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACI LYN REITZ
Provider Business Mailing Address
First Line : 1206 W SOUTH JORDAN PKWY STE D
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-5519
Country : US
Telephone Number : 801-302-3801
Fax Number : 801-302-7248
Provider Business Practice Location Address
First Line : 1206 W SOUTH JORDAN PKWY STE D
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-5519
Country : US
Telephone Number : 801-302-3801
Fax Number : 801-302-7248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2025
Last Update Date : 06/22/2026

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Directions to “ STACI LYN REITZ ” Practice Location

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