MEDICARE: LANCE CRESSALL

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	10859794-3501	UT

General Provider Information

NPI Number	:	1023564051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE CRESSALL

Provider Business Mailing Address
First Line	:	7250 BALMER ST BLDG 533
Second Line	:
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5009
Country	:	US
Telephone Number	:	801-777-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 BALMER ST BLDG 545
Second Line	:
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-7909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	04/11/2023

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Directions to “ LANCE CRESSALL ” Practice Location

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