Healthcare Provider Details

I. General information

NPI: 1447626437
Provider Name (Legal Business Name): SONJA ANN HANSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONJA ANN ANDERSON CSW

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 S VINE ST STE 6
MURRAY UT
84107-7746
US

IV. Provider business mailing address

5411 S VINE ST STE 6
SALT LAKE CITY UT
84107-7746
US

V. Phone/Fax

Practice location:
  • Phone: 801-905-1619
  • Fax:
Mailing address:
  • Phone: 801-905-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8716883-3502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8716883-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: