Provider Demographics
NPI:1851698187
Name:DAVIS, CYNNAMON RAE (CSW)
Entity Type:Individual
Prefix:MS
First Name:CYNNAMON
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CHIPETA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1222
Mailing Address - Country:US
Mailing Address - Phone:801-587-2460
Mailing Address - Fax:801-281-5787
Practice Address - Street 1:697 W 4170 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-1326
Practice Address - Country:US
Practice Address - Phone:801-587-2460
Practice Address - Fax:801-281-5787
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6903653-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical