Healthcare Provider Details

I. General information

NPI: 1073291704
Provider Name (Legal Business Name): MEGAN LYNN ANDERSEN CSW, CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W CACHE VALLEY BLVD STE 5C
LOGAN UT
84341-8475
US

IV. Provider business mailing address

835 S 150 E
SMITHFIELD UT
84335-1660
US

V. Phone/Fax

Practice location:
  • Phone: 435-538-2152
  • Fax:
Mailing address:
  • Phone: 435-279-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: