MEDICARE: MARTA GRADILONE RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YS0200X	School Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1720966443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA GRADILONE RODRIGUEZ

Provider Business Mailing Address
First Line	:	861 S 700 E APT 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-4275
Country	:	US
Telephone Number	:	347-291-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4234
Country	:	US
Telephone Number	:	801-917-6020
Fax Number	:

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

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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