Individual
ILEANA MARIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1743 REDSTONE CENTER DR, PARK CITY, UT 84098-7929
(435) 658-9200
Mailing address
360 MOULTON LN, HEBER CITY, UT 84032-3842
(240) 606-5599
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12300414-3501
UT
Other
Enumeration date
03/07/2023
Last updated
07/14/2023
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