Provider Demographics
NPI:1245190073
Name:DAVIS, JOAN E
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 200 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2127
Mailing Address - Country:US
Mailing Address - Phone:801-210-9319
Mailing Address - Fax:801-210-2090
Practice Address - Street 1:1570 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1006
Practice Address - Country:US
Practice Address - Phone:801-210-9319
Practice Address - Fax:801-210-2090
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8869625381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical