Provider Demographics
NPI:1609964659
Name:WHITE, LESLIE M (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 HIGHLAND DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2674
Mailing Address - Country:US
Mailing Address - Phone:801-278-8859
Mailing Address - Fax:801-278-8504
Practice Address - Street 1:4190 HIGHLAND DR STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2674
Practice Address - Country:US
Practice Address - Phone:801-278-8859
Practice Address - Fax:801-278-8504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT122349-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT122349-3501OtherCLINICAL SOCIAL WORKER