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NPI Code Detail

MEDICARE: TERI NANETTE MICHAELIS CSW

MEDICARE: TERI NANETTE MICHAELIS CSW
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 Worker9816091-3502UT

General Provider Information

NPI Number : 1326497207
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERI NANETTE MICHAELIS CSW
Provider Business Mailing Address
First Line : 440 S 500 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-2705
Country : US
Telephone Number : 801-359-8862
Fax Number :
Provider Business Practice Location Address
First Line : 440 S 500 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-2705
Country : US
Telephone Number : 801-359-8862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2016
Last Update Date : 06/10/2016

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Directions to “ TERI NANETTE MICHAELIS CSW” Practice Location

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