MEDICARE: SALT CITY WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3083029-3501	UT

General Provider Information

NPI Number	:	1073048195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT CITY WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	2670 S 2000 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1782
Country	:	US
Telephone Number	:	801-960-2550
Fax Number	:	801-550-9757

Provider Business Practice Location Address
First Line	:	2670 S 2000 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-1782
Country	:	US
Telephone Number	:	801-960-2550
Fax Number	:	801-550-9757

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY HAWKINS
Credential	:	LCSW
Telephone Number	:	801-550-0700

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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Directions to “SALT CITY WELLNESS, PLLC ” Practice Location

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