MEDICARE: MS. JULIE L RAEL 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	6733029-3501	UT

General Provider Information

NPI Number	:	1104151232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE L RAEL LCSW

Provider Business Mailing Address
First Line	:	7434 S. STATE STREET
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84047
Country	:	US
Telephone Number	:	801-566-4423
Fax Number	:	801-566-4779

Provider Business Practice Location Address
First Line	:	7434 S. STATE STREET
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84047
Country	:	US
Telephone Number	:	801-566-4423
Fax Number	:	801-566-4779

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	03/26/2013

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