Provider Demographics
NPI:1427491562
Name:BRANDT, LEANNE MARIE (DVM)
Entity type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARIE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 E PIONEER FORK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3614
Mailing Address - Country:US
Mailing Address - Phone:801-871-0600
Mailing Address - Fax:
Practice Address - Street 1:308 W 7200 S
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1041
Practice Address - Country:US
Practice Address - Phone:801-871-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1174042801174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT117404-2801OtherSTATE LICENSE
UT117404-2801OtherSTATE LICENSE