MEDICARE: TAYLOR RILEY JOHNSON

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

General Provider Information

NPI Number	:	1326474966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR RILEY JOHNSON

Provider Business Mailing Address
First Line	:	5138 N 2700 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-5597
Country	:	US
Telephone Number	:	435-327-0529
Fax Number	:

Provider Business Practice Location Address
First Line	:	5138 N 2700 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-5597
Country	:	US
Telephone Number	:	435-327-0529
Fax Number	:

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

Provider Enumeration Date	:	09/15/2013
Last Update Date	:	09/15/2013

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