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NPI Code Detail

MEDICARE: LISA MCLAUCHLIN CSW

MEDICARE: LISA MCLAUCHLIN 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
1104100000XSocial WorkerLMSW 13304AZ
2104100000XSocial Worker8394164-3502UT

General Provider Information

NPI Number : 1770870800
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MCLAUCHLIN CSW
Provider Business Mailing Address
First Line : 724 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1830
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 724 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1830
Country : US
Telephone Number : 801-487-0499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2011
Last Update Date : 01/31/2013

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