MEDICARE: SHANLEE ROBERTSON COLLINWOOD C.P.M.

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	174H00000X	Health Educator
2	174N00000X	Lactation Consultant (Non-RN)
3	176B00000X	Midwife	LM218	AZ
4	374J00000X	Doula
5	176B00000X	Midwife	10513702-3400	UT

General Provider Information

NPI Number	:	1538616594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANLEE ROBERTSON COLLINWOOD C.P.M.

Provider Business Mailing Address
First Line	:	1148 E 2700 S APT 60
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-2647
Country	:	US
Telephone Number	:	470-588-6464
Fax Number	:	801-477-8451

Provider Business Practice Location Address
First Line	:	1148 E 2700 S APT H60
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2647
Country	:	US
Telephone Number	:	470-588-6464
Fax Number	:	801-477-8451

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	03/27/2024

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