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Individual

LESLIE BROSIUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L. C. S. W

Contact information

Practice address
7434 S STATE ST, MIDVALE, UT 84047-2014
(801) 566-4423
(801) 566-4779
Mailing address
7434 S STATE ST, MIDVALE, UT 84047-2014
(801) 566-4423
(801) 566-4779

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
55459253501
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1417138710
BLUE CROSS
UT
Enumeration date
11/15/2007
Last updated
08/08/2012
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