Provider Demographics
NPI:1093154304
Name:WEBER, DAVID O III (LCSW/MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:WEBER
Suffix:III
Gender:M
Credentials:LCSW/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9331
Mailing Address - Country:US
Mailing Address - Phone:801-253-0770
Mailing Address - Fax:
Practice Address - Street 1:9910 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9331
Practice Address - Country:US
Practice Address - Phone:801-253-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134267-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical