MEDICARE: JAMIE LEA HALES LCSW

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	6619461-3501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083927800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LEA HALES LCSW

Provider Business Mailing Address
First Line	:	825 N 300 W
Second Line	:	SUITE N221
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1459
Country	:	US
Telephone Number	:	801-824-0827
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 N 300 W
Second Line	:	N221
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1459
Country	:	US
Telephone Number	:	801-824-0827
Fax Number	:	801-823-4584

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

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	12/10/2021

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