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General NPI Number Information
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NPI Number | 1659448652
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Entity Type | Individual
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Provider Name | ESPRA L ANDRUS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 9253 S REDWOOD RD SUITE B
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City | WEST JORDAN
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State | UT
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Zip | 84088-5816
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Country | US
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Telephone | 801-318-5879
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Fax | 801-568-2891
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Provider Business Mailing Address
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Address Line | PO BOX 742
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-0742
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Country | US
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Telephone | 801-318-5879
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Fax | 801-568-2891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 274971-3501
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License Number State | UT
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