Individual
MR. ROBERT E BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
9160 S 300 W, SUITE 22, SANDY, UT 84070-2655
(801) 716-0440
(801) 208-1011
Mailing address
9160 S 300 W, SUITE 22, SANDY, UT 84070-2655
(801) 716-0440
(801) 208-1011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
362807-3501
UT
Other
Enumeration date
05/06/2009
Last updated
05/06/2009
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