Individual
ANDREA ELLIS BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2072 N MAIN ST STE 205, NORTH LOGAN, UT 84341-1700
(435) 213-1638
Mailing address
43 N 750 E, LOGAN, UT 84321-4945
(435) 752-5302
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
6790474-3502
UT
Other
Enumeration date
10/30/2019
Last updated
07/26/2023
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