=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730900135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UTAH TRAUMA SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2024
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15243 S REINS WAY
-----------------------------------------------------
City | BLUFFDALE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84065-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-440-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15243 S REINS WAY
-----------------------------------------------------
City | BLUFFDALE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84065-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-440-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAROLINE LORENZEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 801-440-8695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------