Gina Marie Attallah, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

49721143501 Issued in UT

Practice address

2525 S Lake Park Blvd
Optumhealth
West Valley City, UT 84120-8230

Phone

(801) 982-3064

Fax

(801) 982-3159

NPI assigned

Jan 25, 2006

Last updated

Sep 11, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1679543185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 S 1700 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082970",
            "telephone_number": "801-971-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 S LAKE PARK BLVD",
            "address_2": "OPTUMHEALTH",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841208230",
            "telephone_number": "801-982-3064",
            "fax_number": "801-982-3159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTALLAH",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "49721143501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "49721143500001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTRMTN. HEALTH CARE",
            "identifier": "10704211101",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.