Provider Demographics
NPI:1265784805
Name:BIESINGER, MALINDA WINTERTON (LCSW, MA)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:WINTERTON
Last Name:BIESINGER
Suffix:
Gender:F
Credentials:LCSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 W 13400 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6419
Mailing Address - Country:US
Mailing Address - Phone:424-465-2855
Mailing Address - Fax:
Practice Address - Street 1:4651 W 13400 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6419
Practice Address - Country:US
Practice Address - Phone:424-465-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2021-03-09
Deactivation Date:2018-05-09
Deactivation Code:
Reactivation Date:2021-03-08
Provider Licenses
StateLicense IDTaxonomies
UT8277458-3502104100000X
CALCSW691701041C0700X
UT8277458-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker