Provider Demographics
NPI:1114539855
Name:STAHELI, ZERA LOGAN
Entity type:Individual
Prefix:
First Name:ZERA
Middle Name:LOGAN
Last Name:STAHELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 S 650 W
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9139
Mailing Address - Country:US
Mailing Address - Phone:385-335-4054
Mailing Address - Fax:
Practice Address - Street 1:66 E STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2637
Practice Address - Country:US
Practice Address - Phone:801-876-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12348482-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical