MEDICARE: PD PSYCHOLOGICAL SERVICES PLLC

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

General Provider Information

NPI Number	:	1922873074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PD PSYCHOLOGICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	314 N CENTER ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1625
Country	:	US
Telephone Number	:	773-645-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 N CENTER ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-1625
Country	:	US
Telephone Number	:	773-645-1707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICK DAWLEY
Credential	:	LCSW
Telephone Number	:	773-645-1707

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	06/21/2026

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