MEDICARE: KAREN J CRIST LCSW

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	141437-3501	UT

General Provider Information

NPI Number	:	1184681918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN J CRIST LCSW

Provider Business Mailing Address
First Line	:	1399 S 7TH E
Second Line	:	SUITE #5
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2149
Country	:	US
Telephone Number	:	801-484-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1399 S 7TH E
Second Line	:	SUITE #5
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2149
Country	:	US
Telephone Number	:	801-484-4377
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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