MEDICARE: MS. WENDY JAMES SIMEK 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	1292343501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1292343501	OTHER	UT	CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1558417311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY JAMES SIMEK LCSW

Provider Business Mailing Address
First Line	:	3125 KENNEDY DR APT 306
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2170
Country	:	US
Telephone Number	:	801-910-9351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 KENNEDY DR
Second Line	:	#306
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2168
Country	:	US
Telephone Number	:	801-910-9351
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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