Healthcare Provider Details

I. General information

NPI: 1639204126
Provider Name (Legal Business Name): LEANN O CASTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 E MURRAY HOLLADAY ROAD
SLC UT
84117
US

IV. Provider business mailing address

1440 E IRONWOOD AVE CASTO
SLC UT
84121
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-9342
  • Fax:
Mailing address:
  • Phone: 801-278-9342
  • Fax: 801-308-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1234163501
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: