Provider Demographics
NPI:1619270295
Name:NEWSOME, MELINDA STOUT (MSW, CSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:STOUT
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2630
Mailing Address - Country:US
Mailing Address - Phone:801-969-3307
Mailing Address - Fax:
Practice Address - Street 1:3392 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2630
Practice Address - Country:US
Practice Address - Phone:801-969-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT671562935021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical