Active NPI
Terra Spencer, CSW
- Clinical Social Worker
- South Jordan, UT
National Provider Identifier
1144057407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12954391-3502
- Practice address
- 3674 W South Jordan Pkwy
South Jordan, UT 84009-7159 - Phone
- (801) 349-9606
- NPI assigned
- Sep 19, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12954391-3502 | UT | Primary |
Addresses
Primary practice location
3674 W South Jordan Pkwy
South Jordan, UT 84009-7159
Mailing address
10907 S Lake Island Dr
South Jordan, UT 84009-1322
Phone (253) 988-8149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 10, 2025 through Jan 10, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12954391-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726704000000",
"number": "1144057407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10907 S LAKE ISLAND DR",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840091322",
"telephone_number": "253-988-8149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3674 W SOUTH JORDAN PKWY",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840097159",
"telephone_number": "801-349-9606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "TERRA",
"credential": "CSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-19",
"last_updated": "2024-09-19",
"certification_date": "2024-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "12954391-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Jordan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.