MEDICARE: MRS. JANET BENNION METCALF

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	5331976-3501	UT

General Provider Information

NPI Number	:	1063436228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET BENNION METCALF

Provider Business Mailing Address
First Line	:	9465 S 2805 W
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3301
Country	:	US
Telephone Number	:	801-254-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 S 700 E STE 203
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2422
Country	:	US
Telephone Number	:	801-938-5151
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/03/2009

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