Basic Information
| Provider Information | |||||||||
| NPI: | 1477805372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HESS | ||||||||
| FirstName: | LEEANNE | ||||||||
| MiddleName: | MERIN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 LEWIS AND CLARK CIR | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840143418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013909931 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1208 E 3300 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841062522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014831600 | ||||||||
| FaxNumber: | 8014831610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 276248-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.