Healthcare Provider Details

I. General information

NPI: 1720161912
Provider Name (Legal Business Name): PATRICIA S BENNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W 800 S
ROOSEVELT UT
84066-3707
US

IV. Provider business mailing address

PO BOX 345
NEOLA UT
84053-0345
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6300
  • Fax: 435-725-6325
Mailing address:
  • Phone: 435-725-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137380-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: