Healthcare Provider Details

I. General information

NPI: 1972031185
Provider Name (Legal Business Name): ANDREA MERRIAM DONOVAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 S BENTLEY BLVD STE 4
CEDAR CITY UT
84720-1822
US

IV. Provider business mailing address

1156 S BENTLEY BLVD STE 4
CEDAR CITY UT
84720-1822
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-4966
  • Fax: 435-586-4939
Mailing address:
  • Phone: 435-586-4966
  • Fax: 435-586-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8510156-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: