Provider Demographics
NPI:1982391892
Name:TELFORD, CASEY (CM)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TELFORD
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11978 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7403
Mailing Address - Country:US
Mailing Address - Phone:801-839-4384
Mailing Address - Fax:801-747-6858
Practice Address - Street 1:11978 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7403
Practice Address - Country:US
Practice Address - Phone:385-695-0125
Practice Address - Fax:801-747-6858
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTCCM-00303171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty