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NPI Code Detail

MEDICARE: MICHELLE SWENSON TEEL LCSW

MEDICARE: MICHELLE SWENSON TEEL 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
1104100000XSocial Worker3507363501UT

General Provider Information

NPI Number : 1669458493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE SWENSON TEEL LCSW
Provider Business Mailing Address
First Line : 1113 EMERSON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2527
Country : US
Telephone Number : 801-230-7064
Fax Number :
Provider Business Practice Location Address
First Line : 3944 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-1600
Country : US
Telephone Number : 801-261-1442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 07/08/2007

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Directions to “ MICHELLE SWENSON TEEL LCSW” Practice Location

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