MEDICARE: MS. LAUREL ROMNEY

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	103K00000X	Behavior Analyst
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	10374812-3501	UT

General Provider Information

NPI Number	:	1154870244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL ROMNEY

Provider Business Mailing Address
First Line	:	325 W 700 N APT 6
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1386
Country	:	US
Telephone Number	:	801-785-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 E FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1531
Country	:	US
Telephone Number	:	801-785-8870
Fax Number	:

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

Provider Enumeration Date	:	09/29/2016
Last Update Date	:	03/20/2023

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