Provider Demographics
NPI:1821281221
Name:MUSSON ROSE, DEVON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:
Last Name:MUSSON ROSE
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 1:350 S 400 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2905
Mailing Address - Country:US
Mailing Address - Phone:801-582-5534
Mailing Address - Fax:801-582-5540
Practice Address - Street 1:350 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2905
Practice Address - Country:US
Practice Address - Phone:801-582-5534
Practice Address - Fax:801-582-5540
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT671049935011041C0700X
UT6710499-35011041C0700X
NCC0083471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical