Healthcare Provider Details

I. General information

NPI: 1386888915
Provider Name (Legal Business Name): LAURA LANDWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SLC UT
84148-0001
US

IV. Provider business mailing address

500 FOOTHILL BLV
SLC UT
84747-0000
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-5609
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number367027-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: