Provider Demographics
NPI:1386685618
Name:MASON, CONNIE C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 WAGSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5118
Mailing Address - Country:US
Mailing Address - Phone:801-272-5653
Mailing Address - Fax:
Practice Address - Street 1:625 E 8400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0525
Practice Address - Country:US
Practice Address - Phone:801-566-2556
Practice Address - Fax:801-566-2639
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114014 35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical