MEDICARE: GREATER HEALTH OF NORTHERN UTAH

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

General Provider Information

NPI Number	:	1013717867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER HEALTH OF NORTHERN UTAH

Provider Business Mailing Address
First Line	:	2650 WASHINGTON BLVD STE 210
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3623
Country	:	US
Telephone Number	:	801-833-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 WASHINGTON BLVD STE 210
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3623
Country	:	US
Telephone Number	:	801-833-2218
Fax Number	:

Authorized Official
Title or Position	:	CLAIMS MANAGER
Name	:	WHITNEY PACE
Credential	:
Telephone Number	:	801-657-8270

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	03/21/2025

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