Healthcare Provider Details

I. General information

NPI: 1659897270
Provider Name (Legal Business Name): RACHAL ADELLE BUCHANAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11639 S 700 E STE 100
DRAPER UT
84020-8298
US

IV. Provider business mailing address

2155 JEFFERSON AVE
OGDEN UT
84401-1605
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-6642
  • Fax: 801-621-6776
Mailing address:
  • Phone: 801-389-5119
  • Fax: 801-621-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number264244-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: