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NPI Code Detail

MEDICARE: MARY MAGIE READE L.C.S.W.

MEDICARE: MARY MAGIE READE L.C.S.W.
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
11041C0700XClinical Social Worker12911293501UT

General Provider Information

NPI Number : 1588002208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MAGIE READE L.C.S.W.
Provider Business Mailing Address
First Line : 650 S KOMAS DR STE 207A
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1241
Country : US
Telephone Number : 801-587-9779
Fax Number : 801-585-5845
Provider Business Practice Location Address
First Line : 650 S KOMAS DR STE 207A
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1241
Country : US
Telephone Number : 801-587-9779
Fax Number : 801-585-5845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2013
Last Update Date : 06/05/2013

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Directions to “ MARY MAGIE READE L.C.S.W.” Practice Location

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