MEDICARE: KATHRYN DELLA PIANA 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	1349183501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11807547	OTHER		CAQH

General Provider Information

NPI Number	:	1518024231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN DELLA PIANA LCSW

Provider Business Mailing Address
First Line	:	4516 S 700 E
Second Line	:	STE 185
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-8316
Country	:	US
Telephone Number	:	801-261-3500
Fax Number	:	801-261-2111

Provider Business Practice Location Address
First Line	:	4516 S 700 E
Second Line	:	STE 185
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-8316
Country	:	US
Telephone Number	:	801-261-3500
Fax Number	:	801-261-2111

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/04/2018

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