Provider Demographics
NPI:1467856211
Name:PRANGER, SAMANTHA LIN (CSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LIN
Last Name:PRANGER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LIN
Other - Last Name:PEHRSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:3336 S PIONEER PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2085
Mailing Address - Country:US
Mailing Address - Phone:801-313-0555
Mailing Address - Fax:801-313-9669
Practice Address - Street 1:3336 S PIONEER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2085
Practice Address - Country:US
Practice Address - Phone:801-313-0555
Practice Address - Fax:801-313-9669
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10378315-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health