MEDICARE: JONATHAN MICHAEL STILES LICSW, LCSW

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
1	1041C0700X	Clinical Social Worker	14194009-3501	UT
2	1041C0700X	Clinical Social Worker	30701	MN

General Provider Information

NPI Number	:	1992283618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MICHAEL STILES LICSW, LCSW

Provider Business Mailing Address
First Line	:	3780 S WEST TEMPLE STE 200
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4515
Country	:	US
Telephone Number	:	801-895-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 S WEST TEMPLE STE 200
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4515
Country	:	US
Telephone Number	:	801-895-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	08/22/2025

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