Healthcare Provider Details

I. General information

NPI: 1437432614
Provider Name (Legal Business Name): BRANDON AEGERTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E STE 100
MURRAY UT
84121-1850
US

IV. Provider business mailing address

411 GRANT ST
SALT LAKE CITY UT
84116-2725
US

V. Phone/Fax

Practice location:
  • Phone: 801-872-5516
  • Fax: 801-212-9942
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8620527-3501
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: