Provider Demographics
NPI:1790836393
Name:ANDERSON, KENT TAYLOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:TAYLOR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 FOOTHILL DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1489
Mailing Address - Country:US
Mailing Address - Phone:801-463-2425
Mailing Address - Fax:
Practice Address - Street 1:2319 FOOTHILL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1489
Practice Address - Country:US
Practice Address - Phone:801-463-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT495944735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical