=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730518747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE LEAVITT LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2013
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1399 S 700 E STE 12-E
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84105-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 891-556-1611
-----------------------------------------------------
Fax | 801-953-0982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 669 E MILTON AVE
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84105-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-556-1611
-----------------------------------------------------
Fax | 801-953-0982
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 5566912-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------