Healthcare Provider Details

I. General information

NPI: 1639718463
Provider Name (Legal Business Name): LAURA BENNION LCSW, LASUDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8171 N IRON HORSE DR
LAKE POINT UT
84074-3496
US

IV. Provider business mailing address

376 S 740 W UNIT 104
PLEASANT GROVE UT
84062-2266
US

V. Phone/Fax

Practice location:
  • Phone: 571-205-8505
  • Fax:
Mailing address:
  • Phone: 801-362-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4834233-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number4834233-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: