Provider Demographics
NPI:1427723899
Name:MAHALLATI, ISIS (CSW)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:MAHALLATI
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 E HIDDEN VALLEY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5881
Mailing Address - Country:US
Mailing Address - Phone:801-815-0345
Mailing Address - Fax:
Practice Address - Street 1:13133 S 1300 E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9153
Practice Address - Country:US
Practice Address - Phone:801-826-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical