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MR. KEITH MICHAEL LEDERHAUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CSW

Contact information

Practice address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 322-4257
Mailing address
474 7TH AVE UNIT B, SALT LAKE CITY, UT 84103-3046

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Enumeration date
01/11/2012
Last updated
01/11/2012
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