Provider Demographics
NPI:1972906485
Name:BARDSLEY, MYRIAM L
Entity Type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:L
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E 1400 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3853
Mailing Address - Country:US
Mailing Address - Phone:385-325-2428
Mailing Address - Fax:801-489-8960
Practice Address - Street 1:230 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1922
Practice Address - Country:US
Practice Address - Phone:385-325-2428
Practice Address - Fax:801-489-8960
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94072703501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870285565012Medicaid