Stacey Davis
Social Worker, Clinical in Provo, UT. Individual provider (NPI-1).
NPI number1073809489
StatusActive
Last updated in NPPESJan 17, 2025
Details
- NPI
- 1073809489
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Stacey Davis
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 23, 2011
- Certification date
- Jan 17, 2025
- Last updated
- Jan 17, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL SOCIAL WORKER
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 5425606-3502 | UT | Yes |
Practice location
750 N Freedom BlvdProvo, UT 84601-1677
Phone 801-373-4760
Mailing address
750 N Freedom Blvd Ste 300Provo, UT 84601-1690
Phone 801-373-4760
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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