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NPI Code Detail

MEDICARE: MS. DEVON MUSSON ROSE LCSW

MEDICARE: MS. DEVON MUSSON ROSE 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 Worker67104993501UT
21041C0700XClinical Social Worker6710499-3501UT
31041C0700XClinical Social WorkerC008347NC

General Provider Information

NPI Number : 1821281221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEVON MUSSON ROSE LCSW
Provider Business Mailing Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number : 801-582-5540
Provider Business Practice Location Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number : 801-582-5540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 10/13/2016

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Directions to “ MS. DEVON MUSSON ROSE LCSW” Practice Location

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