Provider Demographics
NPI:1700207958
Name:STEPHENSON, JULIE (SSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:STEPHENSON
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:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0772
Mailing Address - Country:US
Mailing Address - Phone:801-660-6101
Mailing Address - Fax:
Practice Address - Street 1:935 N 240 E
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1221
Practice Address - Country:US
Practice Address - Phone:801-660-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80595323503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker