MEDICARE: JAN R MAGDALEN

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	135045-3501	UT

General Provider Information

NPI Number	:	1922171172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN R MAGDALEN

Provider Business Mailing Address
First Line	:	2071 E ASHTON CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1103
Country	:	US
Telephone Number	:	801-582-2705
Fax Number	:	801-582-2705

Provider Business Practice Location Address
First Line	:	2071 E ASHTON CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1103
Country	:	US
Telephone Number	:	801-582-2705
Fax Number	:	801-582-2705

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/09/2015

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Directions to “ JAN R MAGDALEN ” Practice Location

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