Provider Demographics
NPI:1730382847
Name:MIDGLEY, LYDIA (LCSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MIDGLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 W SOUTH JORDAN PARKWAY
Mailing Address - Street 2:STE B
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-1215
Mailing Address - Country:US
Mailing Address - Phone:801-755-5531
Mailing Address - Fax:801-409-7908
Practice Address - Street 1:1108 W SOUTH JORDAN PKWY STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5505
Practice Address - Country:US
Practice Address - Phone:801-755-5531
Practice Address - Fax:801-409-7908
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6623582-3502104100000X
UT6623582-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker