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NPI Code Detail

MEDICARE: MS. MARA LYN ASHBY C.S.W.

MEDICARE: MS. MARA LYN ASHBY C.S.W.
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 Worker6236651-3502UT

General Provider Information

NPI Number : 1518066075
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARA LYN ASHBY C.S.W.
Provider Business Mailing Address
First Line : 563 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3501
Country : US
Telephone Number : 801-573-7228
Fax Number :
Provider Business Practice Location Address
First Line : 660 S 200 E
Second Line : SUITE 308
City : SALT LAKE CITY
State : UT
Zip : 84111-3835
Country : US
Telephone Number : 801-355-2846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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