Provider Demographics
NPI:1134811938
Name:AHMEDIC, SANELA
Entity type:Individual
Prefix:
First Name:SANELA
Middle Name:
Last Name:AHMEDIC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SANELA
Other - Middle Name:
Other - Last Name:RUJEVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3692 S 545 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1134
Mailing Address - Country:US
Mailing Address - Phone:801-718-7241
Mailing Address - Fax:
Practice Address - Street 1:525 E 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4210
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13404734-3502104100000X
UT13404734-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker