Provider Demographics
NPI:1245702570
Name:ANDERSON, REBECCA A (CSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 E CAMPUS DR STE H
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4514
Mailing Address - Country:US
Mailing Address - Phone:801-789-7780
Mailing Address - Fax:801-789-7700
Practice Address - Street 1:3726 E CAMPUS DR STE H
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4514
Practice Address - Country:US
Practice Address - Phone:801-789-7780
Practice Address - Fax:801-789-7700
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10971916-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10971916-3502OtherPROFESSIONAL LICENSE