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NPI Code Detail

MEDICARE: ROBERT ANDERSON EDD

MEDICARE: ROBERT ANDERSON EDD
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 Worker285544-3501UT

General Provider Information

NPI Number : 1326242967
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT ANDERSON EDD
Provider Business Mailing Address
First Line : 475 W 940 N
Second Line :
City : PROVO
State : UT
Zip : 84604-3301
Country : US
Telephone Number : 801-357-7930
Fax Number : 801-357-7927
Provider Business Practice Location Address
First Line : 475 W 940 N
Second Line :
City : PROVO
State : UT
Zip : 84604-3301
Country : US
Telephone Number : 801-357-7930
Fax Number : 801-357-7927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2007
Last Update Date : 07/08/2007

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Directions to “ ROBERT ANDERSON EDD” Practice Location

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