Individual
MR. RANDY STEVEN WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4055 S 700 E STE 202, SALT LAKE CITY, UT 84107-2504
(801) 209-5134
Mailing address
4055 S 700 E STE 202, SALT LAKE CITY, UT 84107-2504
(801) 209-5134
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
136474-3501
UT
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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