MEDICARE: MARISA MCPECK-STRINGHAM SSW

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	104100000X	Social Worker	6849374-3503	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6849374-3503	OTHER	UT	SSW

General Provider Information

NPI Number	:	1760099733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA MCPECK-STRINGHAM SSW

Provider Business Mailing Address
First Line	:	1133 N MAIN ST STE 128
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4830
Country	:	US
Telephone Number	:	801-541-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST STE 128
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4830
Country	:	US
Telephone Number	:	801-541-7049
Fax Number	:

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

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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