MEDICARE: MRS. MARTINA E BAILEY 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	390200000X	Student in an Organized Health Care Education/Training Program		UT
2	1041C0700X	Clinical Social Worker	11197721-3501	UT

General Provider Information

NPI Number	:	1578922027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTINA E BAILEY LCSW

Provider Business Mailing Address
First Line	:	7533 S CENTER VIEW CT # 4758
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	801-718-9647
Fax Number	:	801-373-0639

Provider Business Practice Location Address
First Line	:	7533 S CENTER VIEW CT # 4758
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5526
Country	:	US
Telephone Number	:	801-718-9647
Fax Number	:	801-373-0639

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

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	05/13/2025

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