MEDICARE: MS. MARCI L PHILLIPS 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	53362913501	UT

General Provider Information

NPI Number	:	1730472283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCI L PHILLIPS LCSW

Provider Business Mailing Address
First Line	:	220 E 3900 S STE 16
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-1571
Country	:	US
Telephone Number	:	801-268-4044
Fax Number	:	801-263-0926

Provider Business Practice Location Address
First Line	:	2565 WELLINGTON ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4009
Country	:	US
Telephone Number	:	801-467-2497
Fax Number	:

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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