Individual
MATTHEW JAMES BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
331 W 2700 S, SOUTH SALT LAKE, UT 84115-2904
(801) 678-3317
Mailing address
331 W 2700 S, SOUTH SALT LAKE, UT 84115-2904
(801) 678-3317
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11705657-3502
UT
Other
Enumeration date
10/30/2023
Last updated
05/29/2024
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