Provider Demographics
NPI:1376572149
Name:DEYOUNG, PATRICIA RUTH (CSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RUTH
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MS
Other - First Name:TRISH
Other - Middle Name:RUTH
Other - Last Name:DEYOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:3232 S 1575 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3355
Mailing Address - Country:US
Mailing Address - Phone:801-755-0928
Mailing Address - Fax:
Practice Address - Street 1:2020 LAKE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3119
Practice Address - Country:US
Practice Address - Phone:801-487-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10254535021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1025453502OtherCSW LICENSE