MEDICARE: DANIELLE LAUREN POWERS MSW, 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
1	1041C0700X	Clinical Social Worker	10335227-3502	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10335227-3502	OTHER	UT	PSYCHOTHERAPIST

General Provider Information

NPI Number	:	1376073965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LAUREN POWERS MSW, LCSW

Provider Business Mailing Address
First Line	:	7050 S HIGHLAND DR STE 220
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3759
Country	:	US
Telephone Number	:	360-612-2688
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 S HIGHLAND DR STE 220
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3759
Country	:	US
Telephone Number	:	360-612-2688
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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