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NPI Code Detail

MEDICARE: MS. CLARE THERESE COONAN LCSW

MEDICARE: MS. CLARE THERESE COONAN 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 Worker3436853501UT

General Provider Information

NPI Number : 1457339384
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CLARE THERESE COONAN LCSW
Provider Business Mailing Address
First Line : 2536 KENWOOD ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3626
Country : US
Telephone Number : 801-963-4280
Fax Number :
Provider Business Practice Location Address
First Line : 3809 W 6200 S
Second Line :
City : KEARNS
State : UT
Zip : 84118-3725
Country : US
Telephone Number : 801-963-4280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/08/2007

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Directions to “ MS. CLARE THERESE COONAN LCSW” Practice Location

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