Provider Demographics
NPI:1699758342
Name:ELDREDGE, DAVID GARY (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GARY
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E 600 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3564
Mailing Address - Country:US
Mailing Address - Phone:801-538-2069
Mailing Address - Fax:
Practice Address - Street 1:280 E 600 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3564
Practice Address - Country:US
Practice Address - Phone:801-538-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT28283735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107012403101OtherINTRMTN. HEALTH CARE
UT780730OtherDESERET MUTUAL
UT942938348ELDOtherEDUCATORS MUTUAL
UT28283735001001OtherBLUE CROSS
UT005550202Medicare PIN
UT780730OtherDESERET MUTUAL
UT28283735001001OtherBLUE CROSS
UT942938348ELDOtherEDUCATORS MUTUAL