=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982057659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA ROGERS SSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2016
-----------------------------------------------------
Last Update Date | 07/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5667 S REDWOOD RD SUITE 6B
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84123-5433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-979-1351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 W HARVARD DR
-----------------------------------------------------
City | MIDVALE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84047-7583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-260-0627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 91975593503
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------