Provider Demographics
NPI:1841853462
Name:ANDERSON, KALANI MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KALANI
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E STE 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2581
Mailing Address - Country:US
Mailing Address - Phone:801-639-9544
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3944
Practice Address - Country:US
Practice Address - Phone:435-248-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1041C0700X
UT1084820035021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical