Provider Demographics
NPI:1588002208
Name:READE, MARY MAGIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAGIE
Last Name:READE
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 1:650 S KOMAS DR STE 207A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1241
Mailing Address - Country:US
Mailing Address - Phone:801-587-9779
Mailing Address - Fax:801-585-5845
Practice Address - Street 1:650 S KOMAS DR STE 207A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1241
Practice Address - Country:US
Practice Address - Phone:801-587-9779
Practice Address - Fax:801-585-5845
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT129112935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical