Provider Demographics
NPI:1801333505
Name:DAHL, DEBRA JO (LMT, SSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JO
Last Name:DAHL
Suffix:
Gender:
Credentials:LMT, SSW
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:WEBSTER-WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2323 W 2220 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-5706
Mailing Address - Country:US
Mailing Address - Phone:801-663-8011
Mailing Address - Fax:
Practice Address - Street 1:2323 W 2220 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-5706
Practice Address - Country:US
Practice Address - Phone:801-663-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7015107-3503104100000X
UT7015107-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty