MEDICARE: ALEKSANDRA MICIC

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	7707373-3501	UT

General Provider Information

NPI Number	:	1538592944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDRA MICIC

Provider Business Mailing Address
First Line	:	7296 W SENTINAL RD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84081-6072
Country	:	US
Telephone Number	:	801-815-6905
Fax Number	:

Provider Business Practice Location Address
First Line	:	7296 W SENTINAL RD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84081-6072
Country	:	US
Telephone Number	:	801-815-6905
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	11/06/2023

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