Provider Demographics
NPI:1881068146
Name:AZOFF, ANDREA JOYCE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOYCE
Last Name:AZOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3005
Mailing Address - Country:US
Mailing Address - Phone:801-564-9200
Mailing Address - Fax:
Practice Address - Street 1:344 E 100 S
Practice Address - Street 2:SUITE 301
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84111-1700
Practice Address - Country:US
Practice Address - Phone:801-322-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5275947-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)