Provider Demographics
NPI:1326372541
Name:PHILLIPS, ANDREA DAE ALLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAE ALLEN
Last Name:PHILLIPS
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 1:7745 S 2325 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5668
Mailing Address - Country:US
Mailing Address - Phone:801-671-4905
Mailing Address - Fax:
Practice Address - Street 1:7745 S 2325 E
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5668
Practice Address - Country:US
Practice Address - Phone:801-671-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical