Provider Demographics
NPI:1073291704
Name:ANDERSEN, MEGAN LYNN (CSW, CTRS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CSW, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S 150 E
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-1660
Mailing Address - Country:US
Mailing Address - Phone:435-279-7618
Mailing Address - Fax:
Practice Address - Street 1:40 W CACHE VALLEY BLVD STE 5C
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-8475
Practice Address - Country:US
Practice Address - Phone:435-538-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical