MEDICARE: SHANDRA AMBER POWELL

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	10067098-3501	UT

General Provider Information

NPI Number	:	1548998875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDRA AMBER POWELL

Provider Business Mailing Address
First Line	:	4465 W 500 N
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8065
Country	:	US
Telephone Number	:	435-590-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4465 W 500 N
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8065
Country	:	US
Telephone Number	:	435-590-2299
Fax Number	:

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

Provider Enumeration Date	:	08/14/2022
Last Update Date	:	08/14/2022

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