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NPI Code Detail

MEDICARE: MR. MICHAEL BLAINE PHILLIPS SSW

MEDICARE: MR. MICHAEL BLAINE PHILLIPS SSW
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
11041C0700XClinical Social Worker12591213-3503UT

General Provider Information

NPI Number : 1972373777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL BLAINE PHILLIPS SSW
Provider Business Mailing Address
First Line : 352 S DENVER ST STE 350
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3059
Country : US
Telephone Number : 801-521-4227
Fax Number :
Provider Business Practice Location Address
First Line : 352 S DENVER ST STE 350
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3059
Country : US
Telephone Number : 801-960-7281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2024
Last Update Date : 01/03/2024

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