Provider Demographics
NPI:1093979379
Name:ANAM CARA
Entity Type:Organization
Organization Name:ANAM CARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:REDENBAUGH
Authorized Official - Last Name:MAGDALEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-582-2705
Mailing Address - Street 1:2071 ASHTON CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1103
Mailing Address - Country:US
Mailing Address - Phone:801-582-2705
Mailing Address - Fax:
Practice Address - Street 1:2071 ASHTON CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1103
Practice Address - Country:US
Practice Address - Phone:801-582-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135045-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR61121Medicare UPIN