MEDICARE: MELISSA WEATHERS 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	7196782-3501	UT

General Provider Information

NPI Number	:	1235429168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WEATHERS LCSW

Provider Business Mailing Address
First Line	:	2067 E 1200 N
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84040-7756
Country	:	US
Telephone Number	:	801-510-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 S MOUNTAIN RD STE 1
Second Line	:
City	:	FRUIT HEIGHTS
State	:	UT
Zip	:	84037-2371
Country	:	US
Telephone Number	:	801-510-5756
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	05/06/2024

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Directions to “ MELISSA WEATHERS LCSW” Practice Location

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