Provider Demographics
NPI:1790921237
Name:WOODRUFF, LAURA BARTHOLOMEW (LCSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BARTHOLOMEW
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 8400 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0525
Mailing Address - Country:US
Mailing Address - Phone:801-566-2556
Mailing Address - Fax:
Practice Address - Street 1:12574 SOUTH REDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-254-9976
Practice Address - Fax:801-566-2639
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359245-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical