Provider Demographics
NPI:1790180008
Name:SONDEREGGER, BRANDICE (CSW)
Entity Type:Individual
Prefix:
First Name:BRANDICE
Middle Name:
Last Name:SONDEREGGER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:BRANDICE
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:6951 S BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6623
Mailing Address - Country:US
Mailing Address - Phone:801-750-9587
Mailing Address - Fax:
Practice Address - Street 1:450 S 900 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2981
Practice Address - Country:US
Practice Address - Phone:801-587-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT641962035021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical