Active NPI
Spencer Kjell Taysom
- Clinical Social Worker
- Provo, UT
National Provider Identifier
1780163295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10906718-3501
- Practice address
- 750 N Freedom Blvd Ste 300
Provo, UT 84601-1690 - Phone
- (801) 373-4760
- NPI assigned
- Aug 7, 2018
- Reactivated
- Aug 9, 2022
- Sex
- Male
- 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 | 10906718-3501 | UT | Primary |
Addresses
Primary practice location
750 N Freedom Blvd Ste 300
Provo, UT 84601-1690
Mailing address
750 N Freedom Blvd Ste 300
Provo, UT 84601-1690
Phone (801) 373-4760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718582400000",
"number": "1780163295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 N FREEDOM BLVD STE 300",
"city": "PROVO",
"state": "UT",
"postal_code": "846011690",
"telephone_number": "801-373-4760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 N FREEDOM BLVD STE 300",
"city": "PROVO",
"state": "UT",
"postal_code": "846011690",
"telephone_number": "801-373-4760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYSOM",
"first_name": "SPENCER",
"middle_name": "KJELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2024-06-17",
"certification_date": "2022-10-11",
"deactivation_date": "2022-06-16",
"reactivation_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "10906718-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.