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NPI Code Detail

MEDICARE: MS. JANET LYNN TENNISON

MEDICARE: MS. JANET LYNN TENNISON
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 Worker3271143501UT

General Provider Information

NPI Number : 1932437944
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANET LYNN TENNISON
Provider Business Mailing Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number :
Provider Business Practice Location Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2009
Last Update Date : 12/02/2009

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Directions to “ MS. JANET LYNN TENNISON ” Practice Location

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