MEDICARE: JENNIFER RUGGERI 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	4955248-3501	UT

General Provider Information

NPI Number	:	1447894951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RUGGERI LCSW

Provider Business Mailing Address
First Line	:	35 W CENTER ST UNIT 224
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-6810
Country	:	US
Telephone Number	:	801-449-0425
Fax Number	:

Provider Business Practice Location Address
First Line	:	8TH AVENUE C ST E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84047
Country	:	US
Telephone Number	:	801-408-4118
Fax Number	:

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

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	08/01/2020

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