# LOOSE CANNON SOCIAL WORK, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811447725
- **Authorized official:** MR. BRUCE CRAIG SOLOMON LCSW (MANAGER)
- **Authorized official phone:** (801) 652-4437

## Contact information

- **Practice address:** 2298 E 200 S, SAINT GEORGE, UT 84790-1603
- **Practice address phone:** (801) 652-4437
- **Mailing address:** 2298 E 200 S, SAINT GEORGE, UT 84790-1603
- **Mailing address phone:** (801) 652-4437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 8202232-3501 | UT | Yes |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 10/04/2016