Provider Demographics
NPI:1790360337
Name:WADSWORTH, BRITTANY (LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:WADSWORTH
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 1:650 W SOUTH TEMPLE APT A300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1031
Mailing Address - Country:US
Mailing Address - Phone:801-907-5854
Mailing Address - Fax:
Practice Address - Street 1:5288 S ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-4536
Practice Address - Country:US
Practice Address - Phone:801-326-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11275797-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty