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NPI Code Detail

MEDICARE: MARY DOVE SSW

MEDICARE: MARY DOVE SSW
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
1104100000XSocial Worker5484223-3503UT

General Provider Information

NPI Number : 1336716851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY DOVE SSW
Provider Business Mailing Address
First Line : 523 HERITAGE PARK BLVD
Second Line :
City : LAYTON
State : UT
Zip : 84041-5711
Country : US
Telephone Number : 385-429-3991
Fax Number : 801-525-6984
Provider Business Practice Location Address
First Line : 523 HERITAGE PARK BLVD
Second Line :
City : LAYTON
State : UT
Zip : 84041-5711
Country : US
Telephone Number : 385-429-3991
Fax Number : 801-525-6984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2021
Last Update Date : 06/04/2021

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