Provider Demographics
NPI:1265493548
Name:EGBERT, SUSAN CUTLER (CSW)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CUTLER
Last Name:EGBERT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9678 S 700 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3592
Mailing Address - Country:US
Mailing Address - Phone:801-518-1115
Mailing Address - Fax:
Practice Address - Street 1:9678 S 700 E
Practice Address - Street 2:SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3592
Practice Address - Country:US
Practice Address - Phone:801-518-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360223-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical