MEDICARE: MRS. LAURA FELSTED JONES 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	172V00000X	Community Health Worker
2	1041C0700X	Clinical Social Worker	7198021-3501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7198021-3501	OTHER	UT	LCSW LICENSE #

General Provider Information

NPI Number	:	1225336803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA FELSTED JONES LCSW

Provider Business Mailing Address
First Line	:	1112 SOUTH 1000 EAST #5
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-5071
Country	:	US
Telephone Number	:	801-696-7923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 SOUTH 1000 EAST #5
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-5071
Country	:	US
Telephone Number	:	801-696-7923
Fax Number	:

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

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	02/20/2015

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