MEDICARE: AJA WASHINGTON 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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	11275798-3501	UT

General Provider Information

NPI Number	:	1285256800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJA WASHINGTON LCSW

Provider Business Mailing Address
First Line	:	585 E 2ND AVE APT 13
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2943
Country	:	US
Telephone Number	:	385-800-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 E 400 S STE 106
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-2859
Country	:	US
Telephone Number	:	385-800-1743
Fax Number	:

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

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	05/30/2025

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