Provider Demographics
NPI:1659448652
Name:ANDRUS, ESPRA L (LCSW)
Entity type:Individual
Prefix:
First Name:ESPRA
Middle Name:L
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0742
Mailing Address - Country:US
Mailing Address - Phone:801-318-5879
Mailing Address - Fax:801-568-2891
Practice Address - Street 1:9253 S REDWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5816
Practice Address - Country:US
Practice Address - Phone:801-318-5879
Practice Address - Fax:801-568-2891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274971-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical