Individual
LAURA B ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5667 SO. REDWOOD ROAD, 6B, SALT LAKE CITY, UT 84123
(801) 979-1351
(801) 905-1161
Mailing address
492 E ELIZABETH DAY CV, DRAPER, UT 84020-5189
(801) 661-1027
(801) 905-1161
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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