MEDICARE: MRS. LEANN O CASTO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1234163501	UT

General Provider Information

NPI Number	:	1639204126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEANN O CASTO LCSW

Provider Business Mailing Address
First Line	:	1440 E IRONWOOD AVE
Second Line	:	CASTO
City	:	SLC
State	:	UT
Zip	:	84121
Country	:	US
Telephone Number	:	801-278-9342
Fax Number	:	801-308-8231

Provider Business Practice Location Address
First Line	:	967 E MURRAY HOLLADAY ROAD
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-278-9342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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