Provider Demographics
NPI:1467699389
Name:THOMPSON, TARALYNN (CSW)
Entity Type:Individual
Prefix:MS
First Name:TARALYNN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 S 900 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5100
Mailing Address - Country:US
Mailing Address - Phone:801-208-1031
Mailing Address - Fax:801-208-1987
Practice Address - Street 1:7575 S 900 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5100
Practice Address - Country:US
Practice Address - Phone:801-208-1031
Practice Address - Fax:801-208-1987
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT69241183502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker