MEDICARE: MISS MELINDA PETTINGILL PATTERSON 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	6365751-3501	UT
2	1041C0700X	Clinical Social Worker	6365751-3502	UT

General Provider Information

NPI Number	:	1578604179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELINDA PETTINGILL PATTERSON LCSW

Provider Business Mailing Address
First Line	:	1983 S 1600 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3846
Country	:	US
Telephone Number	:	801-755-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1291 S 1100 E STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105
Country	:	US
Telephone Number	:	180-175-5979
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/11/2018

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