MEDICARE: ASHLEY GRAEF ASUDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12514799-6018	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174172449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GRAEF ASUDC

Provider Business Mailing Address
First Line	:	4905 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5703
Country	:	US
Telephone Number	:	415-250-5959
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5703
Country	:	US
Telephone Number	:	415-250-5959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	11/17/2022

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