Provider Demographics
NPI:1598809642
Name:CASTLETON, DONNA ELAINE (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ELAINE
Last Name:CASTLETON
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 5600 S
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6174
Mailing Address - Country:US
Mailing Address - Phone:801-268-2887
Mailing Address - Fax:801-268-4295
Practice Address - Street 1:111 E 5600 S
Practice Address - Street 2:SUITE 318
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6174
Practice Address - Country:US
Practice Address - Phone:801-268-2887
Practice Address - Fax:801-268-4295
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118149 35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005562101Medicare PIN