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NPI Code Detail

MEDICARE: MRS. LAURA ELIZABETH SEGO LCSW

MEDICARE: MRS. LAURA ELIZABETH SEGO 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 Worker4930341-3501UT

General Provider Information

NPI Number : 1447359021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA ELIZABETH SEGO LCSW
Provider Business Mailing Address
First Line : 479 EVESHAM DR
Second Line :
City : MURRAY
State : UT
Zip : 84107-6529
Country : US
Telephone Number : 801-261-8366
Fax Number :
Provider Business Practice Location Address
First Line : 660 S 200 E
Second Line : SUITE 308
City : SALT LAKE CITY
State : UT
Zip : 84111-3835
Country : US
Telephone Number : 801-355-2846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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