Unknown Individual – Clinical Social Worker, NPI 1790959807
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2020-11-19. Reason: License revocation, suspension, or surrender.
Clinical Social Worker
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
8541 S REDWOOD RD STE A
WEST JORDAN, UT 840889323
Phone: (801) 233-8670
Type: Location
2743, 9000 West, Magna, Salt Lake County, Utah, 84044, United States
MAGNA, UT 840441128
Phone: (801) 981-8935
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84088)
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