MEDICARE: JANNA MARIE MCGAW 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	101YM0800X	Mental Health Counselor	286085-3501	UT

General Provider Information

NPI Number	:	1801086723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNA MARIE MCGAW LCSW

Provider Business Mailing Address
First Line	:	1399 S 700 E
Second Line	:	11B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2149
Country	:	US
Telephone Number	:	801-792-3802
Fax Number	:	435-645-9409

Provider Business Practice Location Address
First Line	:	265 LOWER EVERGREEN DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5254
Country	:	US
Telephone Number	:	801-792-3802
Fax Number	:	435-645-9409

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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