MEDICARE: MATTHEW ERIC CHRISTENSEN 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	104100000X	Social Worker	8617468-3502	UT

General Provider Information

NPI Number	:	1083051890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ERIC CHRISTENSEN CSW

Provider Business Mailing Address
First Line	:	650 S KOMAS DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1241
Country	:	US
Telephone Number	:	801-587-7813
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 S KOMAS DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1241
Country	:	US
Telephone Number	:	801-587-7813
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	11/12/2021

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