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NPI Code Detail

MEDICARE: AMY K DILWORTH LCSW

MEDICARE: AMY K DILWORTH 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
11041C0700XClinical Social Worker8368695-3501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010150253OTHERIDREGENCE BLUE SHIELD
2L4942OTHERIDBLUE CROSS OF IDAHO

General Provider Information

NPI Number : 1841391422
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY K DILWORTH LCSW
Provider Business Mailing Address
First Line : 5965 S 900 E
Second Line :
City : MURRAY
State : UT
Zip : 84121-1720
Country : US
Telephone Number : 801-263-7138
Fax Number :
Provider Business Practice Location Address
First Line : 5965 S 900 E
Second Line :
City : MURRAY
State : UT
Zip : 84121-1720
Country : US
Telephone Number : 801-263-7138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 01/26/2015

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Directions to “ AMY K DILWORTH LCSW” Practice Location

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