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NPI Code Detail

MEDICARE: JOHN LEO GODFREY LCSW

MEDICARE: JOHN LEO GODFREY LCSW
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 Worker

General Provider Information

NPI Number : 1356002794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LEO GODFREY LCSW
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 833-442-2670
Fax Number :
Provider Business Practice Location Address
First Line : 5373 S GREEN ST STE 40084123
Second Line :
City : MURRAY
State : UT
Zip : 84123-4680
Country : US
Telephone Number : 833-442-2670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2022
Last Update Date : 01/07/2022

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