MEDICARE: DELL CENTER

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	9718974-3501	UT

General Provider Information

NPI Number	:	1093238743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELL CENTER

Provider Business Mailing Address
First Line	:	8641 RANCH CLUB CT
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6283
Country	:	US
Telephone Number	:	410-790-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 SIDEWINDER DR STE 213
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7257
Country	:	US
Telephone Number	:	801-447-2666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA DELL
Credential	:	LCSW
Telephone Number	:	410-790-7119

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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