Healthcare Provider Details

I. General information

NPI: 1518568641
Provider Name (Legal Business Name): VEDANA LEIDY GAUL CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 06/13/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 N 1200 E STE 140
LEHI UT
84043-2247
US

IV. Provider business mailing address

149 N 1200 E STE 140
LEHI UT
84043-2247
US

V. Phone/Fax

Practice location:
  • Phone: 801-251-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13438685-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: