Provider Demographics
NPI:1639694730
Name:VEZIE, LINDA SIMONE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SIMONE
Last Name:VEZIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 S HIMROD CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7658
Mailing Address - Country:US
Mailing Address - Phone:801-891-4428
Mailing Address - Fax:
Practice Address - Street 1:1743 REDSTONE CENTER DR STE 115
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7930
Practice Address - Country:US
Practice Address - Phone:435-658-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334040-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical