MEDICARE: DR. DEENA D STRONG PH.D.

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	295478-3501	UT
2	106H00000X	Marriage & Family Therapist	295478-3902	UT

General Provider Information

NPI Number	:	1861612715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEENA D STRONG PH.D.

Provider Business Mailing Address
First Line	:	2200 E 4500 S
Second Line	:	SUITE 200
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4437
Country	:	US
Telephone Number	:	801-870-8188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 E 4500 S
Second Line	:	SUITE 200
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4437
Country	:	US
Telephone Number	:	801-870-8188
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/18/2011

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