MEDICARE: SLOANE SMITH 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	1390103501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1390103501	OTHER	UT	STATE PROFESSIONAL LICENS

General Provider Information

NPI Number	:	1598734139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SLOANE SMITH LCSW

Provider Business Mailing Address
First Line	:	2124 KING ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1302
Country	:	US
Telephone Number	:	801-783-5660
Fax Number	:	801-783-5559

Provider Business Practice Location Address
First Line	:	124 S 400 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-5306
Country	:	US
Telephone Number	:	801-783-5560
Fax Number	:	801-783-5559

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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