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NPI Code Detail

MEDICARE: THOMAS LASKOWSKI

MEDICARE: THOMAS LASKOWSKI
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
11041C0700XClinical Social WorkerLIC2016-03807UT

General Provider Information

NPI Number : 1306382080
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMAS LASKOWSKI
Provider Business Mailing Address
First Line : 10402 S WEEPING WILLOW DR
Second Line :
City : SANDY
State : UT
Zip : 84070-4244
Country : US
Telephone Number : 801-696-5538
Fax Number : 385-319-7377
Provider Business Practice Location Address
First Line : 1174 E GRAYSTONE WAY STE 6
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2671
Country : US
Telephone Number : 801-696-5538
Fax Number : 385-319-7377
Authorized Official
Title or Position : MENTAL HEALTH THERAPIST
Name : THOMAS LASKOWSKI
Credential : LCSW
Telephone Number : 801-696-5538
Provider Enumeration Date : 01/18/2017
Last Update Date : 07/06/2017

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Directions to “THOMAS LASKOWSKI ” Practice Location

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