Provider Demographics
NPI:1578316196
Name:WHITBECK, MEGAN (SSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WHITBECK
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 1:858 W PANTANI CT
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5724
Mailing Address - Country:US
Mailing Address - Phone:801-209-4001
Mailing Address - Fax:
Practice Address - Street 1:3251 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3170
Practice Address - Country:US
Practice Address - Phone:801-613-4611
Practice Address - Fax:801-613-4601
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6330704-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker