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NPI Code Detail

MEDICARE: LAURA SOUTHWICK

MEDICARE: LAURA SOUTHWICK
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 Worker

General Provider Information

NPI Number : 1851136410
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA SOUTHWICK
Provider Business Mailing Address
First Line : 1809 E SPRINGDALE WAY
Second Line :
City : DRAPER
State : UT
Zip : 84020-8864
Country : US
Telephone Number : 516-581-4652
Fax Number :
Provider Business Practice Location Address
First Line : 3002 W 12600 S
Second Line :
City : RIVERTON
State : UT
Zip : 84065-7119
Country : US
Telephone Number : 801-930-0411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2024
Last Update Date : 06/26/2024

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Directions to “ LAURA SOUTHWICK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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