MEDICARE: SHARON RENA JOHNSON L.C.S.W.

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	49702123501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	827406	OTHER	UT	BLUE CROSS
2	9429838348	OTHER	UT	CHAMPUS
3	942938348SHA	OTHER	UT	EDUCATORS MUTUAL
4	107025298101	OTHER	UT	INTERMTN. HEALTH CARE

General Provider Information

NPI Number	:	1366421299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON RENA JOHNSON L.C.S.W.

Provider Business Mailing Address
First Line	:	6934 WELL SPRING RD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4027
Country	:	US
Telephone Number	:	801-561-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	5965 S 900 E
Second Line	:	#240
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-263-7225
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/14/2012

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Directions to “ SHARON RENA JOHNSON L.C.S.W.” Practice Location

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