Provider Demographics
NPI:1093883027
Name:ANDRUS, AMANDA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ANN
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1247
Mailing Address - Country:US
Mailing Address - Phone:801-531-7389
Mailing Address - Fax:801-364-1433
Practice Address - Street 1:275 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1247
Practice Address - Country:US
Practice Address - Phone:801-531-7389
Practice Address - Fax:801-364-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131494-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical