Provider Demographics
NPI:1427594712
Name:TASE, BECKY JANE (SSW)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JANE
Last Name:TASE
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N 300 E
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2620
Mailing Address - Country:US
Mailing Address - Phone:435-586-6654
Mailing Address - Fax:435-586-6865
Practice Address - Street 1:33 N 300 E
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2620
Practice Address - Country:US
Practice Address - Phone:435-586-6654
Practice Address - Fax:435-586-6865
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT71011513503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker