Susan Michelle Bollow, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7046059-3502 Issued in UT

Practice address

4434 S Highland Dr
Millcreek, UT 84124-3533

Phone

(385) 321-3109

NPI assigned

Jun 4, 2009

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soul Logic Counseling

  • Clinical Social Worker
  • Millcreek, UT
  • NPI 1124853239

  Clinical

  NPD Authorized official
• Center for Human Potential

  • Community/Behavioral Health Agency
  • Salt Lake City, UT
  • NPI 1366679441
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

• Susan Michelle Thorn Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 6, 2024.

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1275769259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2734 E CANTON LN",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840927125",
            "telephone_number": "801-574-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4434 S HIGHLAND DR",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841243533",
            "telephone_number": "385-321-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLOW",
        "first_name": "SUSAN",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-04",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "7046059-3502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275769259",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "THORN",
            "middle_name": "MICHELLE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeannette Beal, MSW, CSW
• Beck Family Therapy PLLC
• Amber Bingham, RBT
• Body and Mind Collective, LLC
• Lisa L Boice, LCSW
• Eric Bonin, TRS, CTRS
• Lindsay Elizabeth Born, DPT
• Gwyneth Grace Borzoni
• Elizabeth Bosen, MSW
• Sheri Bowden, ACMHC

• All providers in Millcreek, UT
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.