Provider Demographics
NPI:1356605851
Name:MILES, LESLIE (SSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 MARKET CENTER DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3740 MARKET CENTER DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8026
Practice Address - Country:US
Practice Address - Phone:801-240-9436
Practice Address - Fax:801-240-9452
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT800748335031041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool