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General NPI Number Information
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NPI Number | 1891296349
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Entity Type | Individual
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Provider Name | STUART MICHAEL LEDBETTER S.S.W
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Gender | Male
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 8781 S REDWOOD RD BLDG 3
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City | WEST JORDAN
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State | UT
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Zip | 84088-9204
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Country | US
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Telephone | 385-468-4617
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Fax |
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Provider Business Mailing Address
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Address Line | 850 E WESTMINSTER AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-3218
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Country | US
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Telephone | 801-518-2052
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 289130-3503
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License Number State | UT
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