Provider Demographics
NPI:1932741188
Name:VANDERSTAPPEN, AMBER (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:VANDERSTAPPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 E EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2305
Mailing Address - Country:US
Mailing Address - Phone:801-808-9235
Mailing Address - Fax:
Practice Address - Street 1:2285 E EMERSON AVE
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-2305
Practice Address - Country:US
Practice Address - Phone:801-808-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7362658-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical