MEDICARE: MS. MARY CANDACE CHRISTENSEN CSW

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	70667033502	UT

General Provider Information

NPI Number	:	1689824963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CANDACE CHRISTENSEN CSW

Provider Business Mailing Address
First Line	:	1348 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2342
Country	:	US
Telephone Number	:	801-971-7866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 WEST 6200 SOUTH
Second Line	:	VALLEY MENTAL HEALTH ARTEC - THERAPEUTIC FOSTER CARE
City	:	BENNION
State	:	UT
Zip	:	84118
Country	:	US
Telephone Number	:	801-955-9686
Fax Number	:

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/26/2008

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