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NPI Code Detail

MEDICARE: JULIETTE CONNELL

MEDICARE: JULIETTE CONNELL
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
1171M00000XCase Manager/Care Coordinator
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1407531858
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIETTE CONNELL
Provider Business Mailing Address
First Line : 455 S 700 E UNIT 2502
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3879
Country : US
Telephone Number : 818-309-0014
Fax Number :
Provider Business Practice Location Address
First Line : 75 E FORT UNION BLVD STE C118
Second Line :
City : MIDVALE
State : UT
Zip : 84047-5512
Country : US
Telephone Number : 801-792-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2023
Last Update Date : 05/13/2025

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Directions to “ JULIETTE CONNELL ” Practice Location

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