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NPI Code Detail

MEDICARE: JASON SCHULZ LCSW

MEDICARE: JASON SCHULZ 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
11041C0700XClinical Social Worker9069104-3501UT

General Provider Information

NPI Number : 1750825436
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON SCHULZ LCSW
Provider Business Mailing Address
First Line : PO BOX 680135
Second Line :
City : PARK CITY
State : UT
Zip : 84068-0135
Country : US
Telephone Number : 415-531-4683
Fax Number :
Provider Business Practice Location Address
First Line : 265 E 100 S STE 250
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1643
Country : US
Telephone Number : 415-531-4683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2016
Last Update Date : 12/14/2016

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Directions to “ JASON SCHULZ LCSW” Practice Location

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