MEDICARE: ALLIES WITH FAMILIES

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1336336445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIES WITH FAMILIES

Provider Business Mailing Address
First Line	:	124 S 400 E STE 250
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-5315
Country	:	US
Telephone Number	:	801-433-2595
Fax Number	:	801-521-0872

Provider Business Practice Location Address
First Line	:	124 S 400 E STE 250
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-5315
Country	:	US
Telephone Number	:	801-433-2595
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LORI N. CERAR
Credential	:
Telephone Number	:	801-433-2595

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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1942339122 — MARIE RUSHFORTH-NUTTALL LPC
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1639776693 — TAEKO MICHELLE COLBERT
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Directions to “ALLIES WITH FAMILIES ” Practice Location

Language	Start Address	Practice Location

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