Logan George Bleazard, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9422103-3501 Issued in UT

Practice address

85 N 300 W Ste a
Washington, UT 84780-3563

Phone

(435) 414-8658

Fax

(435) 359-5247

NPI assigned

Jun 13, 2012

Last updated

Aug 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1306108493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 N 300 W STE A",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847803563",
            "telephone_number": "435-414-8658",
            "fax_number": "435-359-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 N 300 W STE A",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847803563",
            "telephone_number": "435-414-8658",
            "fax_number": "435-359-5247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 N 1680 E Ste T2",
            "address_purpose": "LOCATION",
            "city": "Saint George",
            "state": "UT",
            "postal_code": "847902573",
            "country_code": "US",
            "telephone_number": "435-705-9906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "320 E 600 S",
            "address_purpose": "LOCATION",
            "city": "Saint George",
            "state": "UT",
            "postal_code": "84770",
            "country_code": "US",
            "telephone_number": "435-688-4850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLEAZARD",
        "first_name": "LOGAN",
        "middle_name": "GEORGE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-13",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9422103-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Washington, UT
• Providers in Washington, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.