Provider Demographics
NPI:1982009668
Name:SMALLEY, JAROM DAVE (CSW)
Entity Type:Individual
Prefix:MR
First Name:JAROM
Middle Name:DAVE
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0507
Mailing Address - Country:US
Mailing Address - Phone:801-542-7060
Mailing Address - Fax:801-542-7061
Practice Address - Street 1:8221 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0507
Practice Address - Country:US
Practice Address - Phone:801-542-7060
Practice Address - Fax:801-542-7061
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5504694-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical