MEDICARE: STELLA DADGARI 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	12916355-3501	UT

General Provider Information

NPI Number	:	1881457968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA DADGARI LCSW

Provider Business Mailing Address
First Line	:	4455 S 700 E STE 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3076
Country	:	US
Telephone Number	:	385-202-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 S 700 E STE 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3076
Country	:	US
Telephone Number	:	385-202-0210
Fax Number	:

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

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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