Individual
LEE LEGRAND PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5149 S 1500 W, RIVERDALE, UT 84405-3926
(801) 475-0402
(801) 475-7464
Mailing address
5149 S 1500 W STE 180, RIVERDALE, UT 84405-3926
(801) 475-0402
(801) 475-7464
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
59746953502
UT
1041C0700X
Clinical Social Worker
Primary
5974695-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6
—
UT
Enumeration date
09/16/2006
Last updated
06/18/2019
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