Phyllis Speciale, LCSW
Individual provider Active NPI Clinical Social Worker · Salt Lake City, UT
NPI 1336124387 · NPPES record last updated Apr 9, 2012
Key facts
- NPI
- 1336124387
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1235423501 (UT)
- Practice address
- 1141 E 3900 S
A-170
Salt Lake City, UT 84124-1215 - Phone
- (801) 270-6538
- Fax
- (801) 284-4991
- NPI assigned
- Dec 13, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1235423501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Mental Health Incorporated | Clinical | Past | Accepting new patients |
| Valley Behavioral Health Incorporated | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1235423501 | UT | Yes |
Addresses
Primary practice location
1141 E 3900 S
A-170
Salt Lake City, UT 84124-1215
Mailing address
2640 Chadwick St
Salt Lake City, UT 84106-3506
Phone (801) 467-6617
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All providers in Salt Lake City, UT · Clinical Social Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.