Provider Demographics
NPI:1922377308
Name:LANDWARD, JOHN STAYNER (DSW)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STAYNER
Last Name:LANDWARD
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:STAYNER
Other - Last Name:LANDWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW
Mailing Address - Street 1:3433 E 7590 S
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5439
Mailing Address - Country:US
Mailing Address - Phone:801-272-0714
Mailing Address - Fax:
Practice Address - Street 1:3433 E 7590 S
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5439
Practice Address - Country:US
Practice Address - Phone:801-272-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113157-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health