MEDICARE: SUZANNE PRATT 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	338243-3501	UT

General Provider Information

NPI Number	:	1497959639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE PRATT LCSW

Provider Business Mailing Address
First Line	:	1365 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-484-8838
Fax Number	:	801-483-3010

Provider Business Practice Location Address
First Line	:	1365 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-484-8838
Fax Number	:	801-483-3010

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	10/22/2007

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Directions to “ SUZANNE PRATT LCSW” Practice Location

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