Provider Demographics
NPI:1174501019
Name:LASLEY, LINDA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
Last Name:LASLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LASLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2494 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2416
Mailing Address - Country:US
Mailing Address - Phone:801-582-1125
Mailing Address - Fax:
Practice Address - Street 1:262 E 3900 S
Practice Address - Street 2:SUITE 120
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1550
Practice Address - Country:US
Practice Address - Phone:801-560-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-31
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345136-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT03451363502001OtherBLUE CROSS