MEDICARE: LAMAR GLEN DROLLINGER 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	135368-3501	UT

General Provider Information

NPI Number	:	1366715294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAMAR GLEN DROLLINGER LCSW

Provider Business Mailing Address
First Line	:	1225 FORT UNION BLVD
Second Line	:	215
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1889
Country	:	US
Telephone Number	:	801-233-4200
Fax Number	:	801-233-4239

Provider Business Practice Location Address
First Line	:	1225 FORT UNION BLVD
Second Line	:	215
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1889
Country	:	US
Telephone Number	:	801-233-4200
Fax Number	:	801-233-4239

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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