Provider Demographics
NPI:1407268758
Name:DAVIS, MARIANNE (MSW)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 HARRISON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1271
Mailing Address - Country:US
Mailing Address - Phone:801-393-3113
Mailing Address - Fax:801-394-1910
Practice Address - Street 1:3340 HARRISON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1271
Practice Address - Country:US
Practice Address - Phone:801-393-3113
Practice Address - Fax:801-394-1910
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor