MEDICARE: PROF. ANNETTE MILNER SUDC, CMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6000064-6006	UT
2	101YM0800X	Mental Health Counselor	6000064-6009	UT

General Provider Information

NPI Number	:	1902102858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ANNETTE MILNER SUDC, CMHC

Provider Business Mailing Address
First Line	:	3975 S HIGHLAND DR
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1769
Country	:	US
Telephone Number	:	801-759-1540
Fax Number	:	801-906-8047

Provider Business Practice Location Address
First Line	:	2558 S 900 E STE B
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2239
Country	:	US
Telephone Number	:	801-759-1540
Fax Number	:	801-906-8047

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	07/02/2014

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