Provider Demographics
NPI:1144949355
Name:SHAVER, MARISSA MARIAN (MSW)
Entity type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:MARIAN
Last Name:SHAVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 S 4200 W APT 201
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3401
Mailing Address - Country:US
Mailing Address - Phone:607-287-6627
Mailing Address - Fax:
Practice Address - Street 1:3602 S 4200 W APT 201
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3401
Practice Address - Country:US
Practice Address - Phone:607-287-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11889317-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker