Provider Demographics
NPI:1346229713
Name:ROUMPOS, ANNA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:ROUMPOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:WONDOLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:780 GUARDSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1374
Mailing Address - Country:US
Mailing Address - Phone:801-581-0194
Mailing Address - Fax:801-581-0193
Practice Address - Street 1:780 GUARDSMAN WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1374
Practice Address - Country:US
Practice Address - Phone:801-581-0194
Practice Address - Fax:801-581-0193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT36450735011041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9429384884108A004OtherCHAMPUS
UT591448OtherDESERET MUTUAL
UT107003856101OtherINTERMTN. HEALTH CARE