MEDICARE: LAURA MCINERNEY CSW

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	:	1053927277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCINERNEY CSW

Provider Business Mailing Address
First Line	:	1319 E LUCK SPRING DR
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 S LAKE ERIE DR
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-7350
Country	:	US
Telephone Number	:	385-441-4900
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	11/27/2023

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