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NPI Code Detail

MEDICARE: MATTHEW EDDY MSWI

MEDICARE: MATTHEW EDDY MSWI
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1366104465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW EDDY MSWI
Provider Business Mailing Address
First Line : 930 W HILL FIELD RD STE A
Second Line :
City : LAYTON
State : UT
Zip : 84041-4687
Country : US
Telephone Number : 801-336-3040
Fax Number :
Provider Business Practice Location Address
First Line : 930 W HILL FIELD RD STE A
Second Line :
City : LAYTON
State : UT
Zip : 84041-4687
Country : US
Telephone Number : 801-336-3040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2021
Last Update Date : 10/06/2021

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