Provider Demographics
NPI:1962670265
Name:REDFERN, JOSHUA HAYNES (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:HAYNES
Last Name:REDFERN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 MARKET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8026
Mailing Address - Country:US
Mailing Address - Phone:801-240-9436
Mailing Address - Fax:801-240-9452
Practice Address - Street 1:3740 MARKET CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8026
Practice Address - Country:US
Practice Address - Phone:801-240-9436
Practice Address - Fax:801-240-9452
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6619687-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical