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NPI Code Detail

MEDICARE: MRS. SARA JOHNSON

MEDICARE: MRS. SARA JOHNSON
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 Worker9429908-3502UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2260022408OTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699174409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARA JOHNSON
Provider Business Mailing Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111
Country : US
Telephone Number : 801-582-5534
Fax Number :
Provider Business Practice Location Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number : 801-582-5540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2014
Last Update Date : 06/08/2017

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Directions to “ MRS. SARA JOHNSON ” Practice Location

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