Provider Demographics
NPI:1588990196
Name:AYERS, MARION P (DSW)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:P
Last Name:AYERS
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 S. CONNOR ST.
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2935
Mailing Address - Country:US
Mailing Address - Phone:801-484-0127
Mailing Address - Fax:
Practice Address - Street 1:2865 CONNOR ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1930
Practice Address - Country:US
Practice Address - Phone:801-484-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12057-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical