MEDICARE: DR. LISA M. ORD PHD, 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	294528-3501	UT

General Provider Information

NPI Number	:	1831155621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M. ORD PHD, LCSW

Provider Business Mailing Address
First Line	:	740 2ND AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-3428
Country	:	US
Telephone Number	:	801-560-7549
Fax Number	:	801-467-6157

Provider Business Practice Location Address
First Line	:	699 E SOUTH TEMPLE STE 100G
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1159
Country	:	US
Telephone Number	:	801-560-7549
Fax Number	:

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	11/10/2021

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