Provider Demographics
NPI:1033960620
Name:RADUNICH, MEG BLAIR (ACMHC)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:BLAIR
Last Name:RADUNICH
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 N EASTCAPITOL BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2216
Mailing Address - Country:US
Mailing Address - Phone:925-788-9318
Mailing Address - Fax:
Practice Address - Street 1:7070 S UNION PARK AVE STE 150
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6043
Practice Address - Country:US
Practice Address - Phone:801-528-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13668237-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health