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Organization
LOOSE CANNON SOCIAL WORK, LLC.
Active
Organization
LOOSE CANNON SOCIAL WORK, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE CRAIG SOLOMON LCSW (MANAGER)
(801) 652-4437
Entity
Organization
Contact information
Practice address
2298 E 200 S, SAINT GEORGE, UT 84790-1603
(801) 652-4437
Mailing address
2298 E 200 S, SAINT GEORGE, UT 84790-1603
(801) 652-4437
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
8202232-3501
UT
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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