MEDICARE: LORI BUCK

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	11894777-3501	UT

General Provider Information

NPI Number	:	1699284257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI BUCK

Provider Business Mailing Address
First Line	:	934 S MAIN ST
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-7135
Country	:	US
Telephone Number	:	801-773-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 WASHINGTON BLVD STE 244
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3744
Country	:	US
Telephone Number	:	385-515-4105
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	08/27/2024

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Directions to “ LORI BUCK ” Practice Location

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