MEDICARE: JULIA PUCKETT 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	1041C0700X	Clinical Social Worker	14227037-3502	UT

General Provider Information

NPI Number	:	1154290005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA PUCKETT CSW

Provider Business Mailing Address
First Line	:	124 S 400 E STE 450
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-5306
Country	:	US
Telephone Number	:	801-467-2863
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 S 400 E STE 450
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-5306
Country	:	US
Telephone Number	:	801-467-2863
Fax Number	:

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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