MEDICARE: WEBER HUMAN SERVICES

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1174062590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBER HUMAN SERVICES

Provider Business Mailing Address
First Line	:	4820 S 350 E
Second Line	:	APT A17
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405
Country	:	US
Telephone Number	:	801-686-0310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 S 350 E
Second Line	:	APT A17
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-6292
Country	:	US
Telephone Number	:	801-686-0310
Fax Number	:

Authorized Official
Title or Position	:	COMMUNITY HEALTH WORKER
Name	:	LESLIE ANN JUDKINS
Credential	:
Telephone Number	:	801-686-0310

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/17/2017

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