Individual
MR. JERRY WARREN GROSHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SSW
Contact information
Practice address
237 26TH STREET, OGDEN, UT 84401
(801) 778-6821
Mailing address
1051 ALLEN PEAK CIRCLE, OGDEN, UT 84404
(801) 399-1692
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
134361-3503
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000308007
—
UT
Enumeration date
05/01/2007
Last updated
07/08/2007
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