MEDICARE: MR. DENNIS DEWAYNE PERKINS 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	126874-3501	UT

General Provider Information

NPI Number	:	1306064027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS DEWAYNE PERKINS LCSW

Provider Business Mailing Address
First Line	:	87 E 475 S
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-3539
Country	:	US
Telephone Number	:	801-444-3946
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E NORTH TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84150-0002
Country	:	US
Telephone Number	:	801-240-6428
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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