MEDICARE: DORANNA PUALILILEHUA DALEY LCSW

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	52891973501	UT

General Provider Information

NPI Number	:	1699754549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORANNA PUALILILEHUA DALEY LCSW

Provider Business Mailing Address
First Line	:	5312 W 3830 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2744
Country	:	US
Telephone Number	:	801-718-6474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2588 W 2365 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1249
Country	:	US
Telephone Number	:	801-978-4516
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/08/2007

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