MEDICARE: RYAN M. BUDGE 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	310754-3501	UT

General Provider Information

NPI Number	:	1811399512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN M. BUDGE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 W STATE ROAD 73
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-2901
Country	:	US
Telephone Number	:	801-341-5200
Fax Number	:

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	07/26/2022

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